GPs 'should charge some patients'

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Family doctors should start charging patients for GP services, a group of doctors have said.

Making certain patients pay a fee for some services would "emphasise the value" of GPs, the British Medical Association's (BMA) local medical committees conference was told.


Dr Helena McKeown, a GP from Wiltshire, told delegates that many general practices are struggling to recruit family doctors and charges would help to "build up a workforce".

And GPs creating their own source of funding would mean they could operate outside of political control, the conference heard.

Presenting a motion calling for the BMA's general practitioners committee to "explore national charging for general practice services with the UK governments", she said that years of under-funding for general practice has caused "immense damage".

She said that practices are failing to recruit new GPs which forces them to reduce the services that they offer.

"The time has come to lead our profession in putting a true price on general practice," she said.

"Currently the Government both commissions and controls completely the funding of general practice, so they dictate both what they want, and what they'll pay for, and indeed how much they'll pay for it.

"We are left rationing care in our consulting rooms.

"If we, the cornerstone of the NHS, is to remain firm then money must be committed to pay for general practice.

"A fee for some services, to some people, would sustain us while we build up a workforce who want to join us and make general practice more attractive than retirement or general practice abroad.

"A fixed fee, for some services, for some patients, will emphasise our value. Dedicated funding for general practice will assist practices to take on new GPs.

"If we had funding for GP services we could truly work independently of political control and truly focus on our patients' welfare."

But the motion was shot down from a number of leading medics including the former chairman of the BMA's GP committee Dr Laurence Buckman.

Dr Buckman said: "This motion links unsustainable general practice with charging patients and is therefore mistaken as well as dangerous.

"Why do the proposers come to the conclusion that charging patients will influence demand management? If you want to control demand, manage that. You do not control demand by making patients pay, you then get survival of the richest, not treatment of the sickest."

He added that the introduction of fees would "appall most of the public and the profession".

"Patients would see this as the final nail in the coffin for our NHS, and GPs would be to blame," he said.

"We haven't worked to create our NHS so it would be privatised by ourselves or harm the poor or the sick who would inevitably present later.

"This is an unethical, dangerous, disingenuous and rotten motion."

The conference voted against the motion but agreed on one which said that "general practice is unsustainable in its current format".

Speaking in favour of the motion, Bristol GP Lee Salkeld said: "This motion is not about increasing my personal income or that of any other GP.

"We have to be open and honest and say that primary care is currently struggling to meet the needs of our patients.

"Very few GPs will say that they're doing the best job for all of their patients all of the time because of the financial squeeze we are under.

"Charging patients for primary care services is an important avenue to increase revenue into primary care."

Derbyshire GP John Grenville said: "We have to find a way of protecting those who need our services the most.

"This motion does not say that everyone will have to pay their GP £25 every time they go. This is looking at ways of preserving our NHS.

"We have got to do something. We have got to look at all the options. If the Government is not going to support a national health service, based on need, free at the point of access, funded out of universal taxation, what is it going to do?"

But the majority of delegates rejected the motion.

Speaking against, Derbyshire GP James Betteridge said: "My concerns are that we inadvertently put off patients seeking care who need it most and we will inevitably use NHS money to employ debt collectors."

Hertfordshire GP Katie Bramall-Stainer added that charging patients would be the "death knell for British general practice and the NHS as a whole".

Dr Chaand Nagpaul, chair of the BMA's GP Committee, said that a fee would "undermine" the trust between doctors and their patients and would be a "tax on illness".

He said: "Many GPs are frustrated and concerned about the future of general practice given that many GP practices are struggling from a combination of rising patient demand, falling funding and more work being moved from hospitals into the community. Six out of 10 GPs recently told a BMA survey they were considering retiring from general practice.

"In this climate, it is understandable that the Local Medical Committee conference wanted to debate the need for extra funding for overstretched GP services. But introducing a charge for services would be a tax on illness, hit the most vulnerable the hardest and threaten to undermine the principle of an NHS free at the point of delivery.

"Introducing a financial transaction would undermine the trust between doctor and patient. If patients are deterred from seeing their GP due to an additional cost this could result in their illness deteriorating and costing the NHS even more.

"GPs have today sent a resounding message that charging patients is not the solution to the financial crisis facing the NHS. The BMA is committed to a health service that is free at the point of need and accessible to all and we should proud to have an NHS GP service where no one has to pay to get the treatment they need."

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