Patients should pay up to £20 to see a GP to keep the cash-strapped NHS going, a think tank has said.
The Social Market Foundation (SMF) argues that a charge would make people think twice about visiting the doctor, cutting unnecessary appointments and easing pressure on the health service.
The independent think tank, which includes finance experts and MPs from different parties, made the controversial proposals in a new report.
It said that only the poorest should be entitled to free treatment and called for prescription charges to be introduced for all pensioners. The £7.20 prescription fee paid by most patients for most drugs is currently waived for the over-60s.
The think tank said that such "rationing" of treatment is needed to ensure that the NHS survives the economic downturn.
The SMF's policy advisory panel includes cabinet minister Liam Byrne, Liberal Democrat MP Vince Cable and ex-Scottish Labour Party leader Wendy Alexander.
It said that fees to see a GP would not breach the values of the NHS as people already pay to visit the dentist and for prescriptions.
Report author David Furness said: "It would get people thinking twice about whether the visit was essential.
"If we don't introduce rationing like this, there will be rationing by stealth through waiting lists, crumbling hospitals and poor-quality services."
Copyright © Press Association 2009
What's your view? Should patients be charged to see a GP? Your comments (terms and conditions apply):
"New charges to see GP will be a kind of double tax, but I agree with the proposals to introduce charges for DNA (hospital and GP surgeries)" – Nazma Ansari, address withheld
"Disgraceful. Instead of penalising the poorest yet again, why not set earnings limits over which private medical insurance should be obtained? I would imagine those who can afford private medical insurance would benefit and so would the less well off in our society. I do, however, agreee that DNAs should receive a fine of some sort" – Andrew Mills, Peterborough
"No, because they may delay seeking treatment for a communicable disease – such as TB – and thus infect others. However, since many of the poorest workers in the country are in domestic service and only the wealthy (like those stocking think tanks) can afford personal servants, poetic justice will soon be served" – Elizabeth Walker, Somerset
"The trouble with politicians is that they see a complex problem and, through a lack of understanding, jump to the wrong solution. No one wants to see the 'lazy brigade' get something for nothing again but the consequences of such sweeping generalisations include those already on the breadline making decisions based on what they have left in their purse at the end of the week rather than medical need. Do we want to live in that sort of society when we could examine the open doors we offer to non-UK residents and the health tourism that has been described first? DNAs should carry a small financial penalty which should not be waived for those on benefit, as even those individuals can cancel an appontment if they are not attending! Let's bring a more pragmatic view to this debate and start talking sense about how we realistically manage growing demand" – Wendy Garcarz, Birmingham
"DNA charges are the no-brainer. All that is asked is to cancel unwanted appointments early enough that they can be reused. That's it. Nothing to do with socio-economic status, access, etc. Call or drop in to cancel. If the DH can't start with that, the rest is waffle" – Chris Maude, Reading
"I agree with Bernadette Murphy, however I worry that we are going backwards to the days when it cost 6 pence to see a doctor and many people died from illnesses that could have been easily prevented because they could not afford to see a doctor. Many people who are not entitled to benefits but live very close to the borderline, surviving hand to mouth each month, would be hard pressed to find £20 to see a doctor. Once again, it is these people who would suffer. Can the upper tax brackets not pay, instead of going private for consultations but using the NHS for their treatment?" – Kath Whittall, Stockport
"Not if they turn up but those who DNA should be refused further treatment until and unless they pay a fine. DNAs are the bane of general practice, and it is often the never-worked "I've got rights" brigade who do not attend. Workers who are supporting the lazy brigade tend to turn up because they genuinely need to. My kids, both newly out of uni, work for not much more than the minimum wage, having worked while at uni too – one dealing with coeliac disease. Why should they or anyone else support the lazy brigade? We need to alter this dependence culture and make people take some responsibility for themselves and their families" – Name and address withheld
"I agree wholeheartedly with Bernadette Murphy. As a PM of an innercity practice, we have a high number of tourist patients and because no one in the DH or government will stick their neck out and give us very clear instructions on checking a patient's entitlement to primary care, we end up treating many people for free. I do think patients should be charged for DNAs, even if you are on benefits. It is usually the patients who don't work that do not attend. Pensioners definitely should NOT have to pay for seeing a GP or for prescriptions" – Bernadette Edwards, London
"Yes, let's start charging patients random sums of money on top of an already failing economy and that's supposed to be a solution?! In essence I agree, but then let's stop charging the British Public for National Insurance Contributions and make it Obligatory and not Mandatory. You cannot adopt an ethos of privatisation alongside a public sector payment structure, it's simply one or the other. It is also worth bearing in mind that these 'poor people' tend to be the culture cyclical citizens of this
country, ie, poorly educated, never worked and many never wanted to and the same faces we see each day sat in our GP waiting rooms like some social event. I feel thoroughly insulted that the implication of this 'grand solution' lies in alienating hard-working educated people like myself to work yet even harder to further fund yet more 'poor people' so that I get the privilege of paying national contributions and further private fees on top just to get to see a GP which is one time hardly ever! Having worked in and around our NHS and private sector for nigh on 10 years, I can truly say that this is a grossly unbalanced persepctive on the healthcare system and yes, I find it hugely ironic that this decision has been the culmination of MPs and financiers sat in some 'boys' club' backroom, where 'the bottom line' seems to be the only driver for change" – Mark, Wales
"Yes, charge for repeated DNAs, but what about those genuine people who need to attend regularly? The cost to them could be huge. Do we not run the risk of people failing to seek medical advice until problems can no longer be controlled or until they need multiple drugs when one/none would have been sufficient with early diagnosis? No doubt those on benefits would receive help but there are millions of people who fall just outside benefit levels, work very hard to survive and who couldn't afford to pay for healthcare. If the pressure on health services is reduced enough there is a risk that services will be deemed no longer required and removed and we are back to where we started" – K Wood, North East
"Bernadette Murphy for PM – she's got MY vote! We pay enough already! it's called Tax and NI – just stop the freeloading!" – Steve Cribb, Brighton
"The old people who fought for this country should be charged for prescriptions and people should be made to pay £20 to see a GP!!! Absolutely disgraceful, the NHS needs to shut its doors to freeloading health tourists and start charging all those patients who have booked appointments that don't cancel them or turn up. There is no back up from immigration, DH and the borders agency to caretake treatment of overseas patients, who come here to get their medication every three months because each visit to their own GP in the middle east specifically costs them £100 a time and £100 for a 28-day prescription. GPs have been told this by patients who have inadvertently tripped themselves up – this is what we need to address, not robbing the pensioners of this country, the ones who are most likely to need a GP and who already receive the least amount of benefits to live on. Likewise, GPs need to stop prescribing simple OTC medicines – I have seen mothers leave poorly children in discomfort for up to 48 hours so they can get free calpol from their GP rather than paying £3 to get it immediately from a chemist (they can stump up £3 for 10 Benson & Hedges though). I notice that the list of people included in this think tank does not include any healthcare workers, who actually know how it is in the real world, not in MP cuckoo land" – Bernadette Murphy, Manchester
"As a practice manager I feel that patients should be charged for
appointments especially those patients who do not attend (DNA) My practice has a 15% DNA rate, which means that vulnerable patients wait longer to be seen" – Joyce Jagielko, Ludovixc Medical Practice
"Politicians talking sense at last!" – Gill Forster, Cheshire
"Yes!" – Linda Hall, West Midlands
"I think people in this country are charged enough! I would be interested to see where the money would be going! Perhaps MP expenses! Why not introduce charges for DNAs (like the dentist) instead?" – Warren, Manchester