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Should patients pay to see GP?

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Should patients pay to see the GP? Two doctors debate the issue in the latest edition of The BMJ.

YES
Charging patients for GP consultations could raise much needed funds for the health system, argues David Jones, a foundation year 2 doctor at Worthing Hospital.

The UK NHS prides itself on the mantra of free healthcare at the point of service, but with ever increasing costs and demands "we need fundamental change to ensure its prosperity and longevity," he argues.

In Australia, a standard consultation is typically about £10, with the remainder paid by the government. "No one sees this as unethical — it is the norm," he writes.

And he points out that people in the UK who can afford to already pay towards drug prescriptions and dentistry, "showing that the public accepts that an entirely free healthcare model is not sustainable today."

Vulnerable groups, including children and elderly people, would be exempt from charges, similar to the existing prescription charges exclusion criteria, he explains.

But he adds that charges may offer other benefits, such as a reduction in missed GP appointments, patients taking more personal responsibility, leading to fewer visits with conditions that they could manage themselves, greater service availability, and shorter waiting times.

The argument that charges would deter the sick from seeking help doesn't stand up, he says, as in Australia annual GP attendances per person are comparable to those in the UK.

"Co-payments would not be a vote winning strategy for politicians, but to maintain the highest possible standards for all patients, amid ever increasing healthcare costs, we need radical measures to ensure the continued success of the NHS," he concludes.

NO
Nancy Loader, a GP partner in Suffolk, worries about increased overall cost and harms to patients.

Extensive evidence shows that strong primary care led health systems, free at the point of access, are associated with improved health outcomes, increased quality of care, decreased health inequalities, and lower overall healthcare costs, she writes.

And she explains that in countries that have introduced co-payments, governments "end up reimbursing, capping, and waiving the co-payment to reduce health disparities."

For example, New Zealand and the Irish Republic, where patients have always made a co-payment to GPs, "it has interfered with initial access to care and deterred preventive care measures, resulting in greater health spending in secondary care," she writes.

Charges can also deter patients from seeing the GP as advised after medical or surgical discharge from hospital, she adds. They can encourage patients to collect multiple problems to discuss in a single consultation and pressure doctors to deal with them all at once. And they can encourage unnecessary prescribing or referral.

And she points out that patients who cannot afford to see a GP simply attend free emergency departments instead.

"Keep the NHS free for all at the point of access, not for sentimental or historical reasons, but because it makes good economic sense, is better for healthcare outcomes, reduces bureaucracy, and allows for innovative ways to match supply and demand in general practice," she concludes.

What's your view?
Write to the chairman of Haddenham Medical Centre Patient Participation Group (PPG):
chairman@theppg.org
.......................................

Response One:
It is clear that the NHS will struggle financially in the coming years.
Folk pay for some NHS services already, so I am sure that some would accept charges.
However the introduction of charges will inevitably lead to more admin costs and even greater costs if means testing is involved.

If charging to see your GP leads to a greater demand on already overloaded A&E departments, it would be a retrograde step.There would need to be a charge for visiting A&E as well.

There can be no doubt that NHS care is far more comprehensive in the UK than in many other parts of Europe. I believe that in Spain relatives are required to feed and provide domestic care for patients.

The free movement principle means that people from other parts of Europe obtain care without making much of a financial contribution. The NHS is also not good at charging for care given to visitors from other parts of the world.

The issue of missed appointments is a red herring — this issue is more about education. My wife and I have never missed a medical appointment in 50 years.

This is a very complicated issue; the idea of services being free to pensioners means that many, myself included receive payment relief when we are probably better off financially than young families.

Response Two:
This would deter people from visiting until the problem worsens. Emphasis should be on preventative care.

I already pay my National Insurance contributions.

I have 182 blood and platelet donations credited so far. Making these donations costs me time and money, i.e. travel expenses via public transport and lost work. I am proud to do this.

If we start charging for GP services then the next steps will be privatisation of all medical services, including blood donations — a seriously retrograde step.

Response Three:
The National Health Service must remain FREE from charges. The charge is the thin end of the wedge of privatisation, and this is a disgusting suggestion that people pay for the service they pay their National Insurance for!

Speaking as a person who during Thatchers reign of terror on single parents (I was divorced and working at the time with three small children), many was the time I needed a prescription (I have an inherited heart condition which I didn't know about before having children and becoming divorced), but on collecting the prescription I could not afford the prescription charges so it was never filled. I have no doubts this has made things much worse for me as I have grown older. PREVENTION is definitely better than leaving things due to being unable to pay for a GP visit and health problems getting worse.

At the moment I volunteer to take part in medical research and have left my body to the JR researchers to help with their research They asked me if I would do this, as over the years they have more information on me and my heart condition than any other patient or volunteer. I have had to make a will in order to do this, and I have put in this will that if the NHS is privatised at the time of my death then they will not be allowed to have my body. I know a lot of friends who donate blood and platelets and I know they feel the same way I do if the NHS is privatised then they will no longer give blood or platelets.

If the doctor wanting to charge for his services does not like a NHS free at the point of use, I suggest he removes himself to America where poor people cannot afford medical care, as I am sure he would feel far more at home there, and would not have to see poor people who cannot afford private health care.

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