DR ELLIE CANNON: Charge every patient 50p to see their GP

DR ELLIE CANNON: Help solve the millions wasted on missed NHS appointments by charging every patient 50p to see their GP

In every clinic I sit in, at least one patient fails to show, says Dr Ellie Cannon 

Last month, something I mentioned in my column touched a nerve: a controversial proposal to charge patients a fee of £25 to see their GP.

It wasn’t my proposal, I’d like to point out.

Scores of you wrote in to tell me how ‘ludicrous’, ‘appalling’ and ‘totally unaffordable’ you thought the idea to be. And I agree. A fee of £25 is too expensive.

But – and I know this will anger many – I think a charge of some sort is needed.

The GPs’ magazine GPonline revealed earlier this year that patients fail to attend an estimated 16.4 million appointments a year booked with GPs or other practice staff.

That’s the equivalent of 375 average GP surgeries opening every day of the year without their doctors seeing a single patient. The findings come after analysis of NHS Digital data.

In every clinic I sit in, at least one patient fails to show.

On Friday, for instance, two of our 18 patients booked in for my morning clinic did not show up. Most shockingly, they’d only booked in for their appointment at 8am that morning.

We call it a DNA – did not attend – and there’s rarely a valid reason. Rather it is laziness, disorganisation and profligacy.

For every no-show, there’s at least 20 patients who are forced to wait weeks, and even months, for a potentially life-saving appointment (stock image, GP surgery)

Meanwhile, for every no-show, there’s at least 20 patients who are forced to wait weeks, and even months, for a potentially life-saving appointment.

According to a report out earlier this month, 15 million patients are waiting at least a month to see their doctor. Where I work, the wait is about three weeks, unless it’s a matter of urgency.

I know in my surgery, we have patients queuing outside at 7.30 in the morning. Others, desperate to see someone, resort to turning up at A&E departments.

The shortage of GPs, dwindling finances and increasing pressures has GP practices across the country bursting at the seams.

So, what’s the solution?

It’s a small price to pay to help the NHS

Clearly, a £25 charge per missed appointment is ridiculous. It’s the equivalent of most pensioner’s weekly food budget and would price thousands out of GP surgeries. Readers had other, interesting suggestions. One proposed a deposit system, whereby patients pay a small fee of £10 when booking the appointment, but get it back if they show up.

A few, living in Jersey in the Channel Islands, suggested we copied the system they use there, of charging £49 for a GP visit but offering prescriptions and emergency treatment for free. Alternatively, asked another reader, had I considered the French system, whereby patients pay €25 (£21.50) to the GP directly, but later, via the healthcare system, receive €23 (£19.80) back. Another suggestion was to levy an £8 charge – but only for those aged 16 to 60.

However, others pointed out some obvious pitfalls. ‘What happens if the doctor is late, cancels the appointment or asks you to come back for several follow-ups?’ asked one concerned reader.

Well, I think I have the answer: a fee of just 50p that has to be paid when patients book a new appointment. It’s a charge small enough that’s it’s affordable for most, but large enough to teach patients the value of NHS time.

I’ve posed the idea to colleagues and doctor friends, and many disagree with me. The whole point of the NHS, they say, is that it is free at the point of delivery.

One was sickened by the idea of asking patients for cash.

‘You scupper the doctor-patient relationship once money changes hands,’ she said. Another said there wasn’t any point, telling me: ‘People will come up with excuses about why they can’t pay.’

I told them dogged principles and defeatist attitudes will do nothing to help our increasingly crippled GP services. But a small charge for missed appointments might just.

Same concept as the 5p plastic bag fee

What’s the point of charging a meagre 50p, you might think.

The intention is not to leave patients out of pocket, or stop them from visiting the GP. Instead, it is designed to make people think twice about wasting their doctor’s precious time.

It’s a charge small enough that’s it’s affordable for most, but large enough to teach patients the value of NHS time

Think of it like the 5p charge on plastic bags, introduced in 2015, which saw usage plummet by a staggering 90 per cent. No one thought twice about using the bags before the minuscule charge was introduced. Now, most of us keep a stock of reusable ones in the car boot, even though we’re saving only 10p or 20p.

The same logic should be applied to GP appointments – a price, however small, will remind us of their value.

But wouldn’t collecting money be a logistical nightmare for surgery staff?

We already manage to charge patients for writing medical reports for solicitors, insurance companies and employers. Some surgeries have card- payment facilities, just like small businesses, so it would be pretty straightforward.

There would be no need to waste time chasing payments, either. Patients would pay when they book, either by phone or online.

Alternatively, perhaps they’d have to come into the surgery to pay following a number of DNAs.

Some gyms make you pay for the next class in person if you haven’t shown up for several.

As for what to do with the money, well, my local bakery gives their plastic bag tax to a cancer charity – GP surgeries could do the same.

Or they could use the money to help patients in other ways.

But a quarter of British doctors think this fee is the key to solving the problem of missed appointments, according to a poll by the magazine Pulse.

I reckon the number of missed appointments would plummet, saving practices thousands of pounds and reducing waiting times in the process.

It must be said, I write this piece with a heavy heart. I passionately believe our health service should be free at the point of delivery.

But I’m sick of watching my patients wait nearly a month before they see me.

So, I call on politicians to consider my reasonable proposal.

It might not be a vote winner, but if they genuinely care about the NHS, they will seriously consider it.

Dr Ellie is here to answer your health questions 

Email Dr [email protected] or write to Health, The Mail on Sunday, 2 Derry Street, London W8 5TT.

Dr Ellie can only answer in a general context and cannot respond to individual cases, or give personal replies. If you have a health concern, always consult your GP.

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