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.
Patient-GP relationship
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.
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I don’t think you should pay to visit the doctors – however a refundable appointment deposit scheme should be plausible to save missed – non cancelled fixed appointments. This would be used as an incentive for not booking an appointment and ‘forgetting’ – the same as the dentist would charge.
Good post but I agree with Dino.
I would worry that any charge to see the doctor would deter people from going who actually need to go. So many conditions are best treated early so I could see a situation where people defer visiting the GP. their condition gets much worse and it then costs significantly more to put things right than had they gone to see their doctor immediately.
The proposed scheme could end up costing more. I agree with a small charge for wasted appointments though.
A lot of other countries may well charge for doctor visits, but that’s what stands us apart from those countries.
A charge for any healthcare is fundamentally wrong, in every country. Nobody knows when they will fall ill, or how much it will end up costing, and charging to see a G.P. is the thin end of the wedge.
Education via T.V. like the present anti-smoking ads could do a lot to reduce unnecessary appointments, then there would be no need for a charge. In addition, some areas, like Romsey, expand significantly but the number of G.P.s remain the same. Ergo more G.Ps are needed.
Many years ago I worked as an interpreter in London and was called to hospital / GP surgeries a lot.
The translation / interpreting services for immigrants are essential, but these must have cost the government an awful lot of money. (Translators / interpreters work through agencies.)
The most frustrating thing is that many non-speakers I translated for wasted the GPs’ time, and many GPs told me so. Cancellations happened very often. Some ailments were simply normal cold. The immigrants were not used to the medical system in this country, and they wouldn’t approach pharmacies (and had no English skills to ask for help with a pharmacist.) New immigrants need help within their own community (where they speak the same language and share the same culture), and slowly learn to integrate.
I later interpreted for patients over the phone for some time. When one doctor asked a patient to get her medication at a pharmacy, the patient asked where the pharmacy was and how to get there – because she was totally isolated in the community.
Charging to see a GP is not a solution to our troubled medical system. We can’t have a system where the most vulnerable are deprived of medical care. Even charging for cancellation may not work. You want to charge someone receiving benefits / asylum seekers / new immigrants for missed appointments? Then Social Services may have to foot the bill in some cases. That caused another huge problem.
hmm, £10 for a GP visit; £8.20 for each item prescribed. A “notional fee” could soon start mounting up. If a charge deters unnecessary GP visits and doesn’t deter the necessary ones I see no problem. But it won’t. The unnecessary GP visits will divert to other NHS services; savings on GP services will be negated by increased costs elsewhere. The necessary visits will wait until the condition worsens, resulting in greater treatment costs than would have been necessary if the condition had been treated earlier.
As Chippy says, the main problem with the NHS is the number of people using it who aren’t really ill. The solution, as Larry says, is education, not charging. That final diagram sums it up perfectly and should be more widely circulated
I’ve learnt not to see my GP if I have a cold. A few weeks ago I was half dead but somehow I still survived without having to see my GP. But the duty GP did phone me back and said he couldn’t do anything for me, so I continued my half-dead state for 3 weeks.
This is how things are done in this country. I’m now more educated about not wasting my GP’s time. However it took me years to learn this. And it helps that I found a pharmacist that I could trust. In some oriental culture, a cold is something to be taken very seriously – a visit to the doctor is a must, and taking lots of medication.
What sort of education do you need would be important for patients? Self diagnosis?
Who decides whether a trip to the surgery is necessary? If you think there could be something wrong you visit the GP.
If the GP reassures you that all is OK, was the visit a waste of time? Well, no – you needed the expert advice of the doctor.
The education needs to be where to draw the line. What is *probably* a minor illness and what is *probably* a major illness. And at what point (e.g. after how many days) does a minor illness become a major illness?
I rang my GP in December and was told that if the symptoms lasted for 6 weeks, then he would probably see me. He asked me to just stay at home (being half-dead), take time off if necessary (he said I could take a week off without a sick note (patient’s right), but I only took 2 days off).
Luckily this time the GP was right. (The doctors I visited are mostly right in many diagnoses, so I am grateful.)
However not all patients are that lucky.
I would definitely be in favour of a charge levied against people who simply do not turn up for their appointment, both at GPs’ surgeries and at hospital outpaitients.
If someone rings and cancels, even on the day, that is acceptable, but an awful lot of time and money is wasted on missed appointments.
NHS should always ask patients if they would like a text reminder on their mobiles so that fewer appointments are forgotten.
A friend who works in a doctors’ surgery said that missed appointments amounted to 20 hours in December at her surgery – these appointments could have been given to other patients to reduce their wait.
There are some patients who really ought to be charged a lot. They are the sort who will not take charge of their lives and think that there is a pill for their inability or refusal to cope. Some of these turn up several times a month.
Others need to be seen at frequent intervals for various reasons. As their condition settles, they are seen less. There is no problem with them.
Mothers with children turn up a lot and usually with good reason.
On hearing that a patient is coming with back ache, a GP may moan, ‘Oh no, not him again.’ Or ‘I haven’t seen him for years it must be something important.’
No, charging for visits will not work. Some patients need educating to look after themselves for the trivial things.
There is no need to get a hangover in the first place and a cold is going to last 3 or 5 days whatever you do.
Cuts, bruises and sprains get better with minimal treatment. Learn to look after yourself.
I agree with Dino, re charging for missed appointments.
A charge for missing an appointment would be entirely appropriate, imho.
While it is stated that large numbers of countries charge, do all of them have an NHS type organisation, into which they pay a weekly or monthly sum, which is supposed to cover the cost of their treatment?
Like others, I too am concerned as to how charging would affect those for whom £10 is a lot of money, & similarly, several visits for the same or related problem/s would, if charged at £10/visit, be a disincentive to make that appointment.
The end result could well be a greater cost to the NHS in the end, through hospitalisation of some patients.
We all know & understand the financial situation, re the NHS, but since the changes in doctors contracts, made I think by the previous government but one, matters have changed for the worse, in respect to calls upon NHS services, & the resulting overloads on hospital A & E depts..