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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

9:00 AM

29 June 2013

9:00 AM

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.

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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