Viewpoint: Dr Kailash Chand: GPs should not charge patients for appointments

Family doctors are to vote on charging for appointments at GP surgeries, with fees ranging from £10 to £25 at their annual conference in York later this month. Writing in a personal capacity, BMA deputy chairman Dr Kailash Chand urges them to vote no.

Dr Chand: 'One consequence of charging patients would be to do irreparable damage to the doctor/patient relationship ' Pic  Michele Jones
Dr Chand: 'One consequence of charging patients would be to do irreparable damage to the doctor/patient relationship ' Pic Michele Jones

Some family doctors believe the free care offered by the NHS is ‘unsustainable’ and say a system of charges would deter patients from missing appointments, which costs the NHS millions of pounds every year.

I can understand, 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 problem, and doing so risks serious unintended consequences.

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.

GPs who say it will reduce demand and therefore workload are simply misguided

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

GPs who say it will reduce demand and therefore workload are simply misguided. There are people with genuine problems, who do not 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.

In the past decade, we have wasted taxpayers' money by putting it into the private sector through poorly negotiated PFI deals, inflated consultancy fees and IT failures and unnecessary reorganisations. We have hardly invested in NHS infrastructure, workforce and public health.

Preserve trust between patients and their GPs

One consequence of charging patients would be to do irreparable damage to the doctor/patient relationship and to assist profit-driven private companies to oust GPs from their traditional gatekeeper role, facilitating the creeping privatisation of primary care.

What we should do is ask the government to fund general practice sufficiently, so the 90% of NHS contacts made in primary care are clinically effective, meaningful and safe, reducing the burden on secondary and tertiary care.

Placing that responsibility on patients by indirect payments to the NHS is unnecessary, unwanted and unethical.

In summary, charging patients would have adverse effects. We need to preserve not only the core values of the NHS but trust between patients and their GPs.

* Dr Chand is BMA deputy chairman and is writing in a personal capacity.

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