Should patients pay for access to general practice?

Former health secretary Sajid Javid stirred up debate around the future of the NHS with an opinion piece in The Times suggesting that means-tested fees should be considered to reduce demand for GP appointments and A&E wait times, and that ‘too often the appreciation for the NHS has become a religious fervour and a barrier to reform’ (Javid, 2023). The column prompted former Prime Minister Gordon Brown to write a piece providing the counter argument (Brown, 2023). Brown highlighted how this could create a two-tier health system with the rich paying for private insurance, while those less well-off avoid accessing healthcare until they present late, with more expensive to treat complications: something that has been shown to happen in other countries.

One question I have on this is how would means-tested fees be dealt with? More admin for general practice is probably the last thing that is needed now, and how much would it cost to deal with this additional paperwork? I suspect that a significant proportion of the suggested £20 fee – as used elsewhere in Europe – would be spent managing it. Professor Kamila Hawthorne, chair of the Royal College of General Practitioners, said: ‘Charging patients for GP appointments will not work. It would have the biggest impact on our most vulnerable patients and only increase the administrative burden on GPs and their teams who are already working under immense pressures.’

Some even suggest that when people pay to access primary care, they expect more: longer appointments, the expectation of a prescription to get value for money, and some even turn up with multiple conditions that they've saved up to ‘get their money's worth’. It is unclear that this scheme would reduce demand in the way Mr Javid hopes.

It is undeniable that the NHS is struggling under the current system. As Mr Brown (2023) points out, one way to make a big impact would be to reform funding for social care, focusing on helping older people to stay well at home and reducing pressures on hospitals. This would feed through to helping the wait times in A&E, as people will not be waiting as long for a bed, and help the ambulance service as they will not be waiting so long outside A&E for handovers.

Another ‘reform’ that could be made is focusing on the retention of staff. All political parties suggest training new staff as the answer, but that is a long-term plan. Retaining experienced staff who feel undervalued and overworked would have a big impact, and quickly. In general practice, nurse pay desperately needs to be looked at, as we have discussed here many times before.

What do you think – should patients pay to access general practice? Let us know your thoughts at pn@markallengroup.com.