Should we be charged for visits to the GP?
I heard a report on the radio this week about an article in the British Medical Journal discussing the pros and cons of imposing charges on patients for visits to the GP surgery.
A first reaction might be “whoa, hang on. What about the NHS ‘free at the point of delivery’ ethos?” Yes, but there are already precedents where the patient contributes towards the cost of personal health care. Dental visits are a good example – and many people (myself included) visit a dentist more often than they visit a doctor.
Apparently two-thirds of the developed world already charge for GP visits, so there should be plenty of empirical evidence to assess whether or not such a policy would be beneficial.
Are you actually ill?
We all know that the NHS is in financial dire straits. The main problem, I have heard said (and only slightly tongue-in-cheek) is the number of patients who aren’t actually ill.
A modest charge for visits to the GP would serve to both reduce the NHS’s deficit, and avoid some unnecessary visits. But what about people who really are ill but don’t want to pay the fee? There must be a danger that their condition will deteriorate until more extensive and expensive treatment is required.
The following chart, from The Kings Fund, illustrates the costs of different NHS medical treatments.
Imposing a charge for GP consultations cold mean that patients make more use of the more costly (but free to the patient) options – either because the ailment has reached an extreme condition, or as a ploy to avoid the GP cost.
If a fee were to be imposed, how much should it be? It needs to be low enough for patients to afford. But it also needs to exceed the costs of collection. Otherwise it would be serving merely to restrict demand to GP services – which should absolutely not be the intention.
Incidentally, the radio report suggested that the administration burden would be 120 hours per year for each medical centre.
Speaking subjectively (and as someone who rarely has cause to visit the GP), I would not object to a charge of up to about £10. But I recognise that there are many people – perhaps with lower incomes, larger families, or chronic illness – for whom this amount would be a major hardship.
And how would it affect the patient-GP relationship?
If the GP wants to run some tests, or try some medication and says “come back next week to get the results / see how things are going” are we going to say “but that’s going to cost me another £10. Do I have to?” and try to negotiate a different treatment plan.
If the doctor isn’t sure what our complaint might be (and I’m hoping a doctor will back me up when I say that this happens more often than you would think), are we going to reply “but I’ve paid £10 for this – I want a better outcome”?
Of course, there is a whole raft of options to consider when we are ill – and not always from the NHS. This diagram proceeds a useful guide as to who to consult and when.
Never miss out on another blog post. Subscribe here:
Subscribe to Blog via Email