It would be more equitable to ration out certain cheap drugs and services… than for GPs to offer private weekend work

From my understanding of the current GP contract partners would be breaking their contract terms to see patients in their own partnership as individuals. However, if they form a company and the company sees the patient, the work being contracted out to the GP principals, I am unsure of the state of the contract. It may have to be tested in law. This is the thin edge of a wedge that leads to a two tier service… and evenings during the week may end up similarly private. Overt rationing would be preferable.. Interesting “imbalance of supply and demand” in a profession whose training numbers have been almost entirely controlled / rationed by governments..

Kat Lay reports in The Times 26th Jan 2017: Growing band of GPs back patient fees

GPs are preparing for a showdown with Whitehall over charging patients for appointments as more family doctors broke ranks yesterday to back the idea.

Doctors warned they would not back down after condemnation from MPs, insisting that they face a choice between charging patients and shutting surgeries.

GPs have also privately lobbied ministers over plans to sidestep NHS rules and charge for seeing patients at evening and weekends. While health chiefs insisted that the idea was not valid, it is not clear how GPs could be prevented from going ahead.

Doctors have said that they cannot provide the seven-day services…..

The Times leader:  If the NHS is the nearest thing Britain has to a national religion, some devotees are starting to lose their faith. This year’s winter crisis in hospitals is among the worst in memory. With shrinking resources, general practice is struggling to pick up the slack. We reported yesterday that some GPs have responded with proposals to charge patients for out-of-hours appointments. The idea will be controversial, but it is worth considering.

The proposals do not involve charges for consultations that take place in normal GP opening hours. Instead, patients would pay a fee if they wanted to see their own doctor in the evening or at weekends. They could also have to pay for discretionary procedures such as vasectomies.

The effect would be three-fold. First, this is simply a way of offering more appointments. Second, it would raise cash. With the number of GPs falling, that would help to pay for new doctors. Third, it would manage demand. Patients who worked during normal office hours and with non-urgent complaints would be more inclined to pay for an evening slot, freeing up emergency services and daytime appointments for more pressing cases.

This model would bring Britain into line with most other developed nations. Even western countries considered paragons of social democracy share some of the cost of care with patients. In France and Japan, patients contribute about 30 per cent of the cost of appointments. In Germany, the contribution is capped at 2 per cent of the patient’s income. In Sweden, a visit to the GP costs about £30.

It is not heretical, therefore, to float the idea for the NHS. It is already clear that the right to care “free at the point of delivery” cannot be absolute. Most people pay for their prescriptions, and 1.2 per cent of NHS funding already comes from patient charges. The King’s Fund, a think tank, estimates that the percentage of health service funding raised by national insurance and general taxation is at an all-time high.

The truth is that pouring yet more public money into the NHS is not sustainable. We know that demand will keep growing, partly as a result of an ageing population and partly because expensive new treatments and drugs are constantly becoming available. The state can pick up the tab only by borrowing more or raising taxes. Either option would be bad economics or worse politics.

There are some helpful improvements available at the margins. NHS England plans to train up 1,000 pharmacists to do some of GPs’ simpler jobs, such as blood-pressure checks and medicine reviews. That will relieve pressure if patients are willing to accept a pharmacist’s view. Another proposal under consideration is to fine people who do not turn up for appointments. According to some estimates, there are 14 million missed GP appointments every year. Penalties would help to unclog the system and raise some money.

These are interesting ideas but they will not address the long-term imbalance between supply and demand. Patient charges could. Any new arrangement would have to prevent GPs from using the extra money to supplement their already adequate salaries. Safeguards would also be needed to ensure that a sick person is always seen, regardless of their bank balance. Treating the sick should remain the NHS’s first priority. Unless new sources of revenue are found, however, it will get more strained every year until it finally snaps.


Sir, One cannot blame GPs for considering levying patient charges for out-of-hours cover in the face of wholly inadequate funding (“GPs draw up plans for patient charging”, Jan 25). However, the lessons from NHS dental charges must be learnt. Charges discourage patients who need care — indeed, that is precisely why the government introduced them in the early days of the NHS.

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.

Henrik Overgaard-Nielsen

Chairman of General Dental Practice, British Dental Association

Sir, Am I the only retired GP who remembers providing a 24-hour service to patients, performing minor surgery, carrying out home visits, looking after patients in community hospitals, running minor injuries sessions and a host of other services that were convenient to patients and not all directly remunerated? Luckily, there are still some practices which do provide excellent care for their flock, and I am fortunate enough to be cared for by one. Many, I fear, are cared for by clock-watchers, who have forgotten that they are following a vocation, not just a job. Despite a handsome salary, their limited remit forces local A&E departments to attempt to fill in the gaps, which is both inappropriate and a waste of precious resources.

Dr John Drewer Newton Ferrers, Devon

Sir, GPs charging patients for weekend care stems entirely from Jeremy Hunt’s determination to ram through a seven-day-a-week NHS without putting in the money to pay for it. The government should listen to cross-party voices calling for an NHS and Care Convention with the aim of delivering a sustainable, long term settlement for the NHS and care.

Norman Lamb MP Lib Dem health spokesman, and health minister 2012-15

Sir, Dr Prit Buttar, the Oxfordshire GP leading the initiative to offer enhanced access to certain GP services for payments, says that GPs may decide that their time at weekends and in the evening is more valuable, and that therefore charges are justified. However, might the fact that Dr Buttar has retired at 56 offer us some clues to the pressure on GP resources? In most industries and professions, retirement at 56 is impossible. Are the conditions of GP pensions unsustainably generous, and does this in part explain the shortage of GPs?

Lesley Viner Frampton Mansell, Glos

Sir, Perhaps the time has come for us to reassess our spending priorities. A visit to a beauty parlour, football matches and foreign holidays are affordable to many in all income groups. The NHS budget will always to be overstretched, so maybe those who can pay should pay a contribution towards a consultation, in the same way as one does for NHS dental care, however politically uncomfortable this may be.

Pennie Holt Thornton Cleveleys, Lancs

Sir, The huge reduction in the use of single-use plastic bags since the introduction of the 5p charge shows how behaviour can be changed by the introduction of small fees. One wonders what the impact would be of a £1 charge to see a GP and £5 to go to A&E.

Richard Tweed Croydon

This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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