BMA conference votes to oppose charges for GP appointments

The BMA has voted to oppose charging patients to see a GP or for missing an appointment.

Dr David Wrigley: opposes co-payments for GP services
Dr David Wrigley: opposes co-payments for GP services

The decision by the union's annual representative meeting (ARM) in Bournemouth on Thursday follows a vote by LMCs last month asking GPC to produce a discussion paper on alternative funding options for general practice, including co-payments.

In Northern Ireland, GP leaders are drawing up plans to quit the NHS en masse and introduce charges for patients if 60% of practices sign undated resignations. BMA chair Dr Mark Porter said the motion would not affect the ability of Northern Ireland's GPs to respond to the crisis they face.

Patient charges

The vote by the ARM, the union's highest decision making body, reaffirmed BMA policy in opposition to charges.

Proposing the motion, BMA deputy chair GP Dr David Wrigley - speaking for the north west regional council - said growing calls for charges would 'introduce a consumerist approach' to healthcare that would 'corrode the relationship we have with our patients' and increase demand as patients are discouraged from seeking necessary treatment. 'It would be penny wise, but pound foolish,' he said.

Charges, said Dr Wrigley, 'discourage the poor and disadvantaged from getting the care they need'.

A charging system introduced in Germany in 2004, he said, led to fewer patients seeking treatments they needed, an increase in non-evidence-based treatments, and increased bureaucratic costs to run the system, which was eventually scrapped.

A US study, he added, showed charges led to a 20% increase in risk of death for people with high blood pressure because they were less likely to see a doctor.

Chronic disease

'Faced with charges, the evidence shows, people often do without preventative care and chronic disease management. Patient charges mean they have to decide whether symptoms warrant medical attention.'

Most parents can't tell whether a child's fever is flu or meningitis, said Dr Wrigley. 'Do we really want parents to make the decision whether to take their child to the doctor on the basis of whether these charges will leave enough money to pay their rent?'

Charging patients was a 'zombie policy', said Dr Wrigley, 'a policy that is killed off repeatedly by scientific evidence but it keeps coming back to try and wreak havoc on the NHS'. He added: 'We must not punish our patients for political failure.'

GP Dr Rachel McMahon, representing the LMC conference, opposed the motion. She said LMCs had discussed GP charges and there was no consensus as to whether it would reduce or improve access.

GP workload

'Why was this such an important issue to GPs? It's because of ... workload, and funding and all the pressure this has put on our workforce.'

Dr McMahon said Northern Ireland faced losing a large proportion of its GP workforce over the next 18 months. 'How on earth are they going to cope? What is going to be the solution,' she said.

'We know this is going to be repeated across all four nations. GPs don't want to see charging come about, we want proper funding, that is our plan A, that is what we will fight for. But we have not seen this happening so far, and we see no indication that the new governments are likely to change their strategies.'

GPs were rapidly approaching the moment where there was no alternative, she said.

'What we need is to be ready,' she said. 'We need to know what we can do.' The motion she said would shut the door on GPs' options and prejudice the outcome on the forthcoming GPC discussion paper.

Dr Jessica Ruth Fairfield from the junior doctors' conference said evidence showed that while co-payments could reduce demand they reduced demand equally for effective and ineffective care and reduced demand most  among the poorest patients.

'General practice needs more money, general practice is struggling,' she said. 'But please do not vote in a way that makes our poorest patients in society pay for this. Make the government sort out its own mistakes.'

Dr Porter said the union policy was already opposed to charges. But, he said, passing the motion would not 'affect the ability of GPs in Northern Ireland to respond to the terrible crisis they are facing'.

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