Dr Chris Mimnagh: The ongoing debate about charging for GP appointments

There was a story doing the rounds on social media last week about a GP practice that has started charging for appointments. But, as is often the case, the actual truth is more prosaic than the headlines suggest.

The story is in fact old news from earlier this year and mentions practices charging people not registered with the practice for appointments.

The online reactions prompted me to take a look back through the lens of Google at the ‘GPs to charge for access’ debate.

It's an old chestnut, reheated and chewed over for years. Of course it flies in the face of the ‘free-at-the-point-of-care’ values of the NHS, but it is entirely in keeping with the rise of consumerism and the self-over-others mentality that abounds.

The fact it keeps being rehashed and debated, as it was again at the BMA’s annual representative meeting this year, suggests that the idea is not any where near settled. 

To many of us in the NHS we are there to serve, and feel that service is without thought as to costs.

I’m sorry to say that viewpoint is an evolutionary dead end.

We can feel proud of the Commonwealth Fund report last week that judged the NHS to be the best, safest and most affordable healthcare system out of 11 countries, but when you look at outcomes that halo slips considerably.

If we, the payors, ever realise how poor our value for money is then the NHS could be in trouble. We can’t rely on the ‘who would pay for healthcare when there's a free NHS?’ argument any longer when the NHS is cheap, efficient but not effective.

Already other services are offering fee-for-service healthcare, unencumbered by the need to service impossible demand. The idea that some brave souls have decided to offer a service perceived as personal, prompt and paid-for, while still remaining in contract with the NHS, is possibly the start of an evolution of independent contractor status back to independence from the NHS. 

  • Dr Chris Mimnagh is a GP in Liverpool and head of clinical innovation liaison and deployment at The Innovation Agency, the academic health science network for the north-west coast.

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