Doctors float the idea of patient charges
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- Published: Thursday, 26 January 2017 07:37
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Some GPs are drawing up plans to sidestep NHS rules and charge their patients for weekend or evening appointments, it was reported by the magazine Pulse. But this is opposed by the BMA’s GP committee. NHS England was reported as saying: “All patients have a right to access high-quality primary care services which are free at the point of delivery.”
Under the proposals, drawn up by Prit Buttar, a senior GP in Oxfordshire, patients would have the option of paying if they wanted to be seen more quickly at the surgery. They would also be able to buy procedures such as vasectomies or non-cancerous mole removal at their local GP practice, which family doctors are not paid by the NHS to offer.
They are developing the plans in discussion with colleagues across the country. He said that funding for certain activities at surgeries had increasingly been cut or withdrawn. Contracts forbid family doctors from charging their patients for care but that should change, he said. “There is a huge gulf between the resources the nation has put into general practice and what it expects,” he said. “You can either reduce demand or you can increase the funding, and if the state will not increase funding, we have to do it some other way.”
Dr Buttar has held discussions with local medical committees (LMCs) — which represent GPs’ interests locally and nationally — about implementing a new system by the end of the year. It would get around the restrictions by allowing patients to pay a third-party company for treatment. That company would then pay the GP for their time. No prices have been decided. Dr Buttar said that private arrangements must not affect or delay patients in urgent need of treatment and NHS England would have to approve the plans.
The proposals, revealed by the magazine Pulse, reflect widespread dissatisfaction among family doctors, who earn more than £100,000 a year on average. Last year LMCs called for a ballot on mass resignations from the NHS unless the government offered more funding.
Dr Buttar, 56, who recently retired, said: “If the state wants GPs to open late but it isn’t prepared to pay an adequate sum to cover the costs, I don’t see why they shouldn’t be at liberty to come to a private arrangement to provide it.” He added: “If people decided they wanted a longer appointment on a Saturday or Sunday, the GP might say, ‘I value my time at this amount’, and then they could decide.”
He said that GPs were no longer paid to provide minor surgery and payment for procedures such as fitting women with a contraceptive coil had not risen “anywhere near in line with inflation” and “barely covers the nurse’s time”. As a former surgeon, he is qualified to perform vasectomies, but there is no mechanism for him to be paid by his patients. “I could conceivably do vasectomies on people who were not my patients, but my own patients who know and trust me were not allowed to pay me to do it,” he said.
Doctors criticised the plans. Clare Gerada, a GP in London, said: “I am a firm believer in the NHS and that people should not be mixing private and public at all. I think it corrupts because you never know whether the decision is made according to your best interests or to make money.”
Chaand Nagpaul, chairman of the British Medical Association’s GP committee, said that care irrespective of ability to pay was “a key cornerstone of the NHS, which the vast majority of doctors support”. He added: “The immediate priority is for the government to address the incredible pressure on GP services, which is facing a severe shortage of several thousand doctors and has left 300 GP practices facing closure, according to a recent BMA survey.”
NHS England said: “All patients have a right to access high-quality primary care services which are free at the point of delivery. Strict safeguards are in place to ensure that GPs cannot charge patients for NHS services.”
Henrik Overgaard-Neilsen, Chair of GDPC, wrote in The Times: "Today dental charges are increasingly putting more pressure on an already overstretched health system, as hundreds of thousands of our patients head to A&E — and to GPs themselves — for free treatment that our medical colleagues were never trained to provide. Anyone who thinks that GP charges could serve as a “top-up” for derisory direct funding can also expect disappointment. As dentists know from experience, ministers will just keep asking patients to put in more so that the government can pay less."
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