Doctor 2A £10 charge levied on GP appointments could cut unnecessary appointments, reduce missed consultations and raise vital funds for the NHS, a doctor has said.

Dr David Jones, a foundation year 2 doctor in diabetes and endocrinology at Worthing Hospital, suggested that a charge similar to that employed in Australia would ensure the NHS’s “prosperity and longevity”.

Writing in the British Medical Journal (BMJ), Dr Jones said: “Given that the average patient visits their primary physician 5.5 times a year, a £10 fee, which most GPs would find acceptable, could raise billions of pounds.” It would also potentially lead to a reduction in missed appointments, which currently cost the NHS an estimated £162 million a year, he claimed.

Such a move would also encourage patients to manage and monitor their conditions at home, or with the help of other primary care services, such as pharmacists, dentists and nurses.

In Australia, he argued, such charges are seen as the norm and that there is nothing “unethical” about them.

Under his proposals, vulnerable groups, children and the elderly would be exempt from charges, meaning it would be similar to the existing prescription charges. 

Impact on services 

However, Dr Nancy Loader, a GP partner in Suffolk, expressed concern about the overall cost to payment and impact upon services, writing that the evidence shows that strong primary care-led health systems, free at the point of access, are associated with improved health outcomes, increased quality of care, decreased health inequalities and lower overall healthcare costs.

She added that charges would deter people from seeing the GP as advised after medical or surgical discharge from hospital, or encourage patients to bombard GPs with multiple symptoms or health concerns in a single consultation.

In response to Dr Jones’ suggestion, professor Kamila Hawthorne, Vice Chair of the Royal College of GPs, said: “GPs have a duty to provide healthcare to patients regardless of their ability to pay and the College is against charging patients for GP appointments – a move that would fundamentally change one of the founding principles of the NHS, that healthcare is free at the point of need.

“Even introducing a standardised fee, which is then subsidised by the government, would undoubtedly deter many people from seeking medical help in the early stages of illness when they can be dealt with cost-effectively and efficiently in primary care, rather than requiring expensive specialist care in hospitals.

“Charging for appointments would also be a lot more complicated than it sounds – where does it stop? GPs make contact with patients in a variety of ways, would a charge just be for face-to-face appointments, or phone calls and emails as well? And if charges extend to house calls then there are serious safety implications to consider as GPs could be targeted for carrying cash. 

“Whilst a similar scheme has seen some success in Australia, this has not been the case in countries such as New Zealand and Ireland and there is no guarantee that it would work in the UK. It would also create extra layers of bureaucracy when GP practices are already struggling to cope with unprecedented patient demand, and this would serve only to further keep us away from delivering frontline patient care, which is why we become doctors in the first place.

"General practice is under intense resource and workforce pressures but charging our patients for appointments is not the solution. What we need is more investment in our service and for everything possible to be done to ‘recruit, retain, return’ thousands more GPs over the course of this parliament, so that we can continue to provide safe, free care to all our patients, when they need it.”