The £10 GP Charge

In an act of either smug self-importance, or epic trolling, Dr David Jones, a junior endocrinologist at  Worthing, has written to the BMJ stating that GPs should charge £10 a visit to prevent people wasting appointments. You'll note Dr Jones is not a GP, because any GP who has been practicing more than twenty minutes knows this would be disastrous.

First, how many patients do you think don't get their prescriptions filled because they can't really spare the £8.20? Loads. Way more than you'd imagine, because why else go to the doctor if you're not planning to use the medication you're obviously seeking? Many people don't go to the doctor for a cure, but for answers. If the answer is a medication they can't afford, well at least they know the answer. So, the country already has all these demonstrably unwell people not getting their medicine because of the cost. What's going to happen to all these demonstrably unwell people who cannot afford to go to the doctor's in the first place?

Then you have the people who can afford £10 to visit the GP, and therefore will assume it entitles them to special treatment. You see it all the time. People ask for a referral to the hospital clinic, find out the waiting time, and then decide they would like to go private because they envisage a system where they can be seen on the same day. Their optimism turns to rage when this mythical same-day-service turns out to be a two week wait. Bringing in a GP charge is unlikely to change patient turnover much at all in some areas, so instead there will be a crowd of furious people who have TEN WHOLE POUNDS AND EXPECT TO BE SEEN IMMEDIATELY! You already get this entitlement in the NHS. I cannot tell you how many times someone has huffed "I pay your wages" down the phone because I couldn't give them an appointment for three weeks, like that meant they owned the appointment system. Bring actual money changing hands instead of the invisibility of national insurance contributions and you have a recipe for a lot of upset patients, and stressed, threatened staff.
There would be people who, having paid their £10, would be furious because their three week cold is still a three week cold, and not pneumonia, demanding their money back on the basis of incompetence. And if the GP did get the diagnosis or treatment wrong, what then? Refunds?

Dr Jones seems to think the entire population of Britain has his medical knowledge and thus know when they should or should not seek a GP's advice. They don't. How many people can tell the difference between a viral infection and a bacterial infection when it is happening to them? Even people who are aware of the clinical differences between the two in presentation sometimes need it confirmed by a doctor. When you phone NHS Direct for PRETTY MUCH ANYTHING, they tell you to see your GP immediately or go straight to A+E, which does nothing to help patient anxiety. We have collectively lost our medical common sense in this country, partly as a result of being dependent on the NHS. We are told not to take painkillers for more than 3 days without seeing a GP. We are told to consult our GP before starting an exercise regime. We have to see a GP to be referred to hospital or for a blood test, even for longstanding complaints the GP is well aware of. Pregnant? See the GP, even though s/he will have absolutely nothing to do with your pregnancy care unless you're unwell.

What about when the doctor tells you to come back in a week? Do you have to pay another £10 just to be told you're better? Or when you have to see the GP for medication reviews on a regular basis? Chronic illness, already depressing and financially shite, could become very expensive. I had to have five injections in one week once - that would have been £50 just to stop me dying.

I strongly suspect that if the NHS introduced a £10 GP charge, the only change GPs would see would be a lot more people going to A+E (this already happens in massive numbers when people just can't get an appointment, like A+E give a shit about earache) and a lot more post-mortem reports coming through. Those who can afford to pay £10 for reassurance every time their elbow twangs will continue to waste GP time. Those who cannot afford to pay £10 when they're genuinely very ill will get worse and either overcrowd hospitals or die.

The whole point of general practice is that it's a gateway to medical help. Yes, if your arm is hanging off, you really do need to attend A+E, but what if your arm is just very swollen and painful at the elbow? And then it's your finger joints, your wrist, and then all your joints? And you have to pay £10 to be seen the first time, to have tests ordered, and then £10 to see the doctor again to be told the tests showed up rheumatoid arthritis, and then £10 again to see if the drugs (that you didn't get because you'd just spent your last tenner on the GP) prescribed last time actually worked, and then £10 a few weeks later to see if the drugs that you actually got last time have worked, and then another £10 because the GP forgot to refer you to rheumatology and just needs to check something again...and so on and so on.

GPs are massively oversubscribed, we all know that. If you don't believe me, ring up and find out how long you have to wait for a routine appointment. But GPs don't just deal with ill people and timewasters. It's not a dichotomy of the sick and the well.
They deal with people who are very sick indeed, but seem well. They deal with people who are physically fine, but full of psychosomatic illness because of anxiety or depression. They deal with people who are just lonely, who are slowly dying, who are actually dying right there in the waiting room. They deal with those who are absolutely fine but won't believe it, who seem absolutely fine but are definitely not. They deal with chronic illness, with acute illness, with tiny babies, and with centenarians.
So how to relieve the pressure? How about better patient education and empowerment in dealing with minor ailments? How about NHS Direct not telling absolutely everyone to go to the GP or A+E (down with NHS Direct!)? How about giving pharmacists and nurses more power?

The NHS needs to remain free at the point of access.