Charge to see GP unlikely to raise ‘transformative’ sums, analysis finds

Implementing a charge for GP visits is unlikely to raise a ‘transformative’ sum of money, and advocates are yet to make a solid case for it, according to new analysis. 

The think tank Institute for Government (IfG) has published a report analysing the alternative models suggested by those who think the current NHS funding model is broken. 

This included a switch to social insurance, subsidies for private medical insurance, and additional charges, of which the ‘most common’ proposal is charging for GP visits.

Former Conservative health secretaries Sajid Javid and Ken Clarke have both suggested this year that patients should pay a fee to see their GP, with Mr Clarke saying this should be means-tested.

The IfG has raised a number of potential complications with implementing such a fee, while also pointing out that public appetite for them is low.

Based on there being roughly 350 million appointments in general practice each year in England, if there was a £10 charge to see a GP, this would raise around £3.5bn. 

However, the IfG said it is ‘inconceivable’ that there would not be exemptions on this charge, and that honouring all of those used for prescriptions charges would reduce the income by roughly 90%. 

The report said: ‘Take prescription charges. Some 40% of the population are liable to pay prescription charges, but almost 90% of prescriptions are in fact dispensed free. That is because those who are exempt are among the heaviest users of health services.’

Other issues raised included the fact that ‘only around half’ of the yearly 350 million appointments are with a GP, where the income raised would then be spent, and the bureaucracy required to bill this charge to patients. 

‘There appears to be a core dilemma: a low charge with very few exemptions that would be likely to raise only a couple of billion pounds; or a high charge with larger exemptions in an attempt to raise a more significant sum – although to do that the exemptions would have to be much more restrictive than those currently applied to prescriptions,’ the report added. 

The author also highlighted that a charge for GP visits without an accompanying charge for A&E attendances would result in ‘yet more patients going to overcrowded casualty departments rather than to the GP’.

The analysis said: ‘The challenges of administering a charge in casualty departments barely need to be spelt out and one thing is certain: it would not be a significant money-spinner. 

‘There are typically around 16 million A&E attendances a year. So even say a £20 charge would raise only £320m or so before exemptions and, again, no exemptions is inconceivable.’

The IfG concluded that while a case can be made for introducing charges, proponents of this policy have yet to answer key questions. 

‘Money is always helpful. But on the evidence here, the sums raised are unlikely to be transformative, and there is little public appetite for them,’ the report said.

When Sajid Javid came out in support of charges, Prime Minister Rishi Sunak confirmed he is not ‘currently’ considering the proposals. 

However, during his campaign for the Tory leadership, Mr Sunak set out plans to issue £10 fines to patients who miss GP appointments.

But he later backtracked on the pledge after it was widely criticised by health leaders, and a spokesperson told Pulse that they have actually been shelved following negative feedback from GPs.

However, last month it was reported that this leadership pledge may be back on the table.

And junior health minister Maria Caulfield said in July that the Government is ‘not ruling it out for the future’.

Earlier this year, a survey found that half of patients would support £10 fines for missed appointments as a way of securing additional funding for the NHS.

However, the British Social Attitudes survey found that in 2022 93% believed that the NHS should definitely or probably be free of charge when needed.