NHS GPs should charge for appointments. Here’s why

A dose of stiff upper lip – and a small fee – would soon ease the queues at GPs’ surgeries

29 June 2013

The Chairman of the Royal College of GPs recently said that ‘general practice has radically altered over the last five years, with ballooning workloads and more and more patient consultations having to be crammed into an ever-expanding working day.’

The blame for this tends to be put on a growing and ageing population or an ever-increasing range of ailments. It might also be put on the last Labour government for changing the way in which GPs work, by rewarding them for preventing, not just treating, illness.

Whatever the cause, the solutions are more numerous and often ineffective. NHS Direct is for the most part staffed by poorly trained non-medics who regularly tell people to go to hospital for fear of being sued if the caller dies. Meanwhile, many doctors I have talked to have complained bitterly about the proliferation of forms to be filled in, staff assessments, diversity checks and all the other management — rather than medical — issues which clog their day. A certain amount of admin is inevitable, but they protest that they are doctors, not accountants.

The system may not be at breaking point but it is clearly strained. If doctors, nurses and management cannot do anything more to ease that strain, who can?

We can. The patients.

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Those of us old enough to remember the early days of the NHS may also remember how remarkable it seemed to have all treatment ‘free at the point of delivery’. Because my parents were used to paying when they went to see the doctor, they did so only when it was essential, and that attitude carried over into the new days of free medical treatment. We did not waste the doctor’s time.

My mother was so anxious not to do so that she failed to report early enough a symptom which she thought trivial, but which was actually an early sign of the cancer from which she died. But at the back of her mind was always the fear of bothering the doctor, and the memory of having to pay him if you did.

Minor ailments were always dealt with at home when I was a child, but gradually people forgot how to do that. They went to the doctor at the first sign of a snuffle or a sore finger. Preventive vaccinations apart, the only time I remember being taken to the surgery was after I bent down to pat a dog and it savaged my upper lip. The GP stitched it up himself (without any anaesthetic). Coughs and colds, diarrhoea and sickness, styes and boils did not automatically mean a visit to the surgery, and antibiotics were reserved for serious conditions.

I know a young parent of two small children who visits the GP surgery every time they have a cold or a tummy bug, expects antibiotics and often gets them. But most minor illnesses are self-limiting, even in childhood. Perhaps if we stopped to think before taking the trip to the surgery with nothing-much, the queues would lessen.

There is a type of condition we should categorise as ‘just put up with it’. Things for which there was and is no cure, and which can only sometimes be alleviated by a doctor. I am no fan of quack medicine, but sore, stiff joints and muscle pain can be relieved by massage; chronic pain and discomfort is often eased by osteopathy or acupuncture. Many medicines that used to be prescription-only can be bought over the counter, sometimes with advice from the pharmacist. Ah, yes, but the key word there is ‘bought’, and complementary medicine is not free. Many practitioners of that still have full appointment books, though, and those attending are by no means only the well-off.

I speak to many GPs in the course of writing books with a medical aspect, and for articles such as this, and several of them have said: ‘If everyone who came into my consulting room had to give me five pounds, my surgeries would soon halve.’

Why pay for what you can get for free? Because the population has increased greatly and the NHS cannot now treat every patient for every ailment, however minor, for nothing. Because knowing it would cost a fiver to see a doctor might make people think twice before taking up his appointment time with trivialities.

There would, of course, have to be the usual exclusions — for those over 70 and children under-five, people with serious chronic conditions or on benefits. The rest of us could pay, and those in the exclusion categories who could easily afford to might pay voluntarily. This ought to be money donated to a medical practice, not to some unseen government money-taking department.

Perhaps we could relearn the lessons of previous generations. No one wants a return to the days when people were seriously ill, in pain and even died because they could not afford a doctor, but some careful thought about whether we really could manage without a surgery appointment, knowledge that most minor illnesses get better by themselves, a reminder of simple but effective home remedies, plus a measure of ‘just put up with it’ stoicism, would surely make a dent in the queues at the surgery.

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Show comments
  • Tim

    People will just migrate to A&E to avoid the charges.

    • MellorSJ

      Easy. They pay there too.

  • Teacher

    Good idea.

  • andyfisk

    And the fee that starts small goes up and up and up. People will not attend and ‘just put up with it’ cases end up with a cancer that is too late to be treated.

    • Mike Barnes


      That’s why USA’s healthcare system is so expensive. 50 million people don’t have any insurance so don’t bother going to GPs for minor things.

      Those minor things go unnoticed for years until someday they become major things and they are in hospital getting expensive treatment. The patient can’t afford it, defaults on the payment and goes bankrupt. The government picks up the tab. The tab is obviously much larger than it should have been if it just paid for the patient to get a checkup years ago.

      Charging for GP visits is about the worst idea I’ve ever heard to control NHS costs.

    • Tom M

      Oh what a load of tosh. I weep. It’s either the good old NHS with it’s manifold faults or some money grabbing system like the USA.
      Have any of you ever looked at say France, you know, across the channel. Arguably the best health care system in the world. Publically funded, run in large part by the private sector and people pay for their visits to the GP. If you can’t pay you get help (if you are a foreigner you pay cash).

      For a country that considers animated street protests a public duty nobody seems too exercised at paying for the GP.

      The cancer rates you refer to are better in France by a country mile than in the UK (that is with the population paying for their GP remember).
      Here’s just a few more to help you on your way:

      The GP’s salary is the money patients pay for their visits.

      The GP decides whether or not you should be restricted to your home if you are off work ill (ie no taking a “sickie” and going off on holiday).

      You are issued with a “carte vitale”. It’s a credit card thing that on presentation allows access to your records, anywhere. If given a prescription by the GP you can trot of to (any) chemist and he can bring it up on his screen and dispense it. Funnily enough it’s a computer system and it all works.

      The comparative costs between the NHS and the French system? Last year for which I have figures is 2007. French system 16% more expensive. Please don’t tell me that 16% would remedy the NHS.

  • F. Hugh Eveleigh

    I agree. A small (£5 or £10) payment to the medical practice receptionist would be a move in the right direction provided, as Miss Hill mentions, the money stays within the practice. There will be few who cannot afford the lower figure but if they cannot and can genuinely prove so, then it must remain free for them. I am loathe to admit that France might have one over us but in the case of GP visits they indeed do. The French health system is now top class so quite how much this has to do with up-front payment to GPs I couldn’t say but ‘better to be ill in France than here’ is something I never thought would be widely mentioned in my lifetime. No, we have to do something to break the NHS decline and this is a simple, not expensive initial means of introducing the idea of responsibility – to those who provide the service, to the government which pays for it and to us as individuals responsible for our own lives.

  • E Hart

    A considerable part of the doctors’ work is in doling out repeat prescriptions to all those folk on happy pills in this post-industrial paradise. In 2012, some 46.7m prescriptions were issued for anti-depressants alone. If you’d rather fewer people visited the doctor, it might be worth analysing the nature of these visits. I suspect that many are there because they’re depressed, ill or because as you say, they’re old and ill. A broader view of public health issues – involving cause and effect – would be in order but that isn’t going to happen. When 25% of the adult population can’t get through the day without uppers, we have problem that goes beyond mere health. I suspect that their well-being wouldn’t be improved by contributing further to their stress. Similarly, we have a burgeoning problem with obesity and diabetes, which apparently, has nothing to do with society or economics either.

    Personally, I’d be happy if you were charged top dollar wherever you went. You’d soon get tired of advocating such crude Presbyterian-style cure-all/correctives.

    For info: http://www.imtj.com/news/?EntryId82=211742

    • Peter Bensley

      Leaving aside the skepticism about anti-depressants as off-topic, there is a good point there. Instead of leaving it up to the (largely unqualified) patients to decide whether their issue requires a doctor or not, why doesn’t the system deal with different types of request intelligently?

      Is it necessary to have a doctor fill out every repeat prescription? Do hypochondriacs have to keep getting appointments with the doctor, or could they be referred to mental health practitioners to treat their actual problem?

  • Peter Bensley

    “My mother was so anxious not to do so that she failed to report early enough a symptom which she thought trivial, but which was actually an early sign of the cancer from which she died. But at the back of her mind was always the fear of bothering the doctor, and the memory of having to pay him if you did.”

    And this is what you want us to return to?

    I’m lost for words.

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