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The public were made aware of a heated debate this week with headlines “Charges to See Your GP”. This was the result of the publication of a survey by Pulse magazine, which found that 51% of GPs who replied were in favour a charge for each GP appointment. This, compared to 36% who were against the idea and 13% who were not sure. The same survey last year only found 36% in favour of charges. So what has driven the change?
Doctors are already under enormous pressure coping with a demand for an increasing number of appointments each day. There is a projected doubling of patient appointments to 433 million per year by 2035 and with an increasing elderly population, at least 150 million of these with be people in the 60+ age group. On top of this growth, there are a growing number of Directly Enhanced Services that you are expected to sign up for. However, 45% of GPs have turned down these opportunities, which means doctors are opting to take a real-terms pay cut rather than add to stress. Add in the stresses of interaction with the new CCGs and there is an increased motivation to manage the working day more effectively.
It actually looks more likely that practices will be part of the management system for the Department of Health plans to charge non-EU nationals for primary care. They already pay charges for hospital care and they could be asked to pay a fee per consultation or an annual service fee. Practices will probably have to record new patients' immigration status when they register and the idea is that GPs could be allowed to keep part of the fee for administering the service. There is a logical extension to charging the average patient if doctors signal agreement.
On the other hand, charges are a political `hot potato`, and the Department of Health have signalled a backtracking on all charges (however, this doesn`t mean the idea has gone away). Although it is obvious why doctors are beginning to look at the idea of charging to try to limit the number of wasted appointments for minor ailments, it is not to be taken in isolation to the rest of the health service. If GP visits attract charges, will more patients just turn up at A&E? Will patients see primary care as a `Private` service and be more demanding of the care they receive?
Dr. John Shapter – QCS GP Expert Contributor