Viewpoint: Appointment charges would irreparably damage doctor-patient relationship

Charging patients to see a GP would overturn one of the founding principles of the NHS and the majority of GPs are committed to this ethos.

Dr Chand: '(Charging patients) ... is unnecessary, unwanted and unethical.'
Dr Chand: '(Charging patients) ... is unnecessary, unwanted and unethical.'

GPs are concerned about unmanageable patient demand and their workload with fewer staff at all levels of healthcare, compounded by cuts and so-called efficiency savings.

I believe billing patients for GP appointments is a spurious solution to a very thorny, complex and emotional issue, and doing so risks some serious unintended consequences.

There is a danger that this might appease certain sections of media and those who are apathetic towards the NHS, but disregard the real health challenges facing us. Patient charges undermine the core principles of the NHS, and a system that allowed payments would be regressive, in that it would penalise the poor, the sick and the old - the most frequent users of the NHS.

Such a system would perpetuate inequalities by devolving financial risk to individuals, leaving them to meet the often catastrophic risks of ill health to themselves. Any decision to allow this to happen would foster a two-tier NHS which is undignified and divisive.

GPs who say it will reduce demand and therefore workload, are simply misguided. I don’t think this will happen. There are people with genuine problems, who don’t have money and have to go to food banks. If they are refused treatment because they do not have money, what will happen then? Unfortunately, the poorest sections of society are the unhealthiest and will have to bear the brunt of any such policy the most.

The NHS was created in 1948, at a time when the country was recovering from World War Two. One of its key supporters, Aneurin Bevan, once asserted: ‘No society can legitimately call itself civilised if a sick person is denied medical aid because of a lack of means.’ I don’t believe any GP fundamentally disagrees with that.

In the last decade we have wasted taxpayers’ money into the private sector through poorly negotiated PFI deals, inflated consultancy fees and IT failures. We have hardly invested in NHS infrastructures, workforce and public health issues. The NHS reforms continue unabated in the march to fragment the NHS, fuelling demand by seeking to expand routine NHS work 7/7, 365 days a year.

One of the consequences of charging patients would not only be to do irreparable damage to the doctor-patient relationship, but also to assist profit-driven private companies to oust GPs from their traditional gatekeeper role and facilitate creeping privatisation in primary care caused by the coalition’s NHS shakeup.

People come to see their GPs because they are ill or because we are ensuring that their health is as much their concern as it is ours. The funding in primary care is being stretched to the limits, so much so that it is estimated that the money allocated to family doctors would fall by nearly £200m over the next three years.

What we should do is to ask the government to fund general practice sufficiently so that the 90% of NHS contacts that occur in primary care are clinically effective, meaningful and safe, thus reducing the unnecessary burden on the secondary and tertiary sectors. Placing that responsibility on patients by indirect payments into the NHS is unnecessary, unwanted and unethical.

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