Could you be charged £25 to see your GP?

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Woman in doctor's office frowning

The British Medical Association is set to hold a debate, which will ask doctors to vote on whether GPs should charge for appointments. Some experts argue that this is the best way to stop patients missing appointments - which costs the NHS £152 million a year at the moment.

But is charging the right solution, and could it happen?

Why charge?

The forthcoming debate was highlighted by Pulse, a magazine for GPs. The proposal is to charge somewhere between £10 and £25 for each appointment, which would be payable when the individual makes the booking. The idea is that after people have paid, they would value their appointment more - and as a result would be less likely to miss it.

Pulse did a survey last July, which revealed that over half of GPs would like to see a small fee for routine appointments as a way of managing their workload, and controlling patient demand.

The fees would also go back into the practice itself, to help ease financial pressure too.

This would be a groundbreaking move for the NHS, but it wouldn't be the first national health service to make a charge. In France, Germany and Scandinavia, GPs already charge for appointments, without the collapse of the nation's health.

The Daily Telegraph points out that the idea has been raised here before too. Last year, Andrew Haldenby, director of the Reform think tank, said: "The idea is that people are more responsible about the need to visit their doctor," he said. "Of course it seems almost like an unthinkable move, but in the current circumstances it is reasonable to think the unthinkable."

The issues

The major problem would be the fact that any charge could put people off visiting the doctor. There are already those who put off visiting their GP because they cannot afford £8.05 for their prescription. Adding in another £25 would put this beyond the pockets of many more.

If people fail to see a GP when they need to, it could end up with a significant deterioration in their health, and the risk that conditions will have progressed too far for anything to be done.

Another possible outcome is that these individuals would end up at Accident and Emergency departments instead, in an effort to be treated for free. This would tie up inappropriate services, and would mean those in need of emergency care would end up having their care delayed - with potentially dire consequences.

Will it happen?

The debate is being held at a BMA conference in York. It's not a foregone conclusion that it will pass, as there are plenty of doctors who oppose the idea of fees.

Even Dr Nigel Watson, chief executive of the Wessex local medical committee, which is proposing the motion, told the Daily Mail that he didn't want to charge patients, saying: "Personally I feel that services should be free at the point of access." However, he added that GPs need more resources, and if it's not to come from more taxation or the closure of hospitals, then other sources need to be considered. He added: "Many of us wouldn't want it to come from charging patients but that's why we need a debate."

Even if the vote is passed, the BMA would then need to lobby the Department of Health to persuade them to introduce the fees, which would have to overcome all these concerns, and political fears of a backlash against any government introducing fees.

Alternatives

There are alternatives. There have been calls for more funding for GP practices, to enable them to open for longer and see more patients, without stretching budgets to breaking point. At the moment GPs are in charge of 90% of the NHS contacts for 8.39% of the budget - which they argue is insufficient.

There could be more of a role for community pharmacies, to encourage people to seek help from pharmacists for minor ailments in order to free up GPs for more serious patients.

There could be a triage role within the NHS, which would direct people to the most appropriate services, so that those seeking help from a GP with a cold or a flu could be redirected to a pharmacist, and those seeking medical help when really they need social care could be sent in the direction of more appropriate help.

But what do you think? Should GPs charge for appointments? Or is there a better solution?