Why is charging to see a GP or attend A&E a bad idea?

Whenever reform of the NHS is discussed the possibility that payments to visit your GP or attend A&E is nearly always put forward as a method to reduce unnecessary visits and to raise extra funds.

Most recently in January 2023, the former health secretary Sajid Javid, suggested that means-tested fees be introduced. He referred approvingly to the £20 fee that some European countries charge for visits to the GP, and to the Republic of Ireland’s €75 (£66) bill for attending an A&E as “nominal”.

These flat rate charges or co-payments are common in other countries, and the NHS has a very limited number of these, such as for prescriptions and dental charges. However, the principle that NHS care is free at the point of use is popular with the public, and so any extension in charging would challenge this core idea and is likely to be controversial.

Impact on the use of services?

Arguments have been put forward that as the NHS is free, people are less careful with their use of services, more inclined to book a GP appointment rather than try other services first. Although there will be people who visit GPs unnecessarily, research comparing healthcare use across a number of comparably wealthy countries, has shown that people in the UK generally use less healthcare. 

In fact, the UK has a problem of people not visiting a GP when they should, which would be exacerbated by charges. Research has found that worry about wasting the doctor’s time contributes to delays in cancer diagnosis in the UK, which in turn contributes to poor cancer survival rates compared with other countries.  

There is a large body of evidence that charges may deter patients from attending services. Sajid Javid used the example of GP charges in Ireland to support his argument for these payments, but a study has highlighted several negative effects of the scheme, despite it being means tested. The research found that one in four of adult patients who have to pay for GP consultations had a health problem during a 12 month period but did not see their GP because of cost.

Full story in The Lowdown, 5 July 2023