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Tuesday, 29 August, 2000, 09:05 GMT 10:05 UK
Doctors appointments: Should people pay?
Should people have to pay for doctors appointments? Send us your views.
A new survey suggests many doctors in England are in favour of charging patients 10 for appointments.

They believe this will cut the number of times when a patient arranges to see his or her GP and then does not bother to turn up.

But will this deter people who are less well off from attending their doctor, even if they are ill? Or are doctors who favour the change right to demand an end to time wasting in surgeries?

Your reaction

"Co-payments" of $5 - $15 USD are the rule in the US. While 10 pounds sounds a bit steep ($16.50 USD), the system works well to keep down the overall cost of health insurance (a sore spot to many private industries), and also reduces unneeded visits to doctors for trivial problems. It's an all around win-win solutions. May I suggest a more reasonable amount of 5-8?
Tom, USA

Surely it is only right that those who abuse the system and fail to keep their appointments should be penalised

Wendy, UK
Patients already have to pay through the nose for their prescriptions. Is this a further tax on the sick and disabled? Perhaps a fairer system would be for those who persistently fail to keep appointments, without contacting the surgery to cancel if they are unable to attend, should be removed from the Doctor's list. Say three strikes and you are out.
Surely it is only right that those who abuse the system and fail to keep their appointments should be penalised, not those who are in genuine need.
Wendy, UK

Why should we have to pay to see a Doctor? We pay National Insurance and surely that is what the NHS is for? The fact that they are incapable of making sure the money goes to the right places is not something that "Joe Public" should be penalised for.
Bridget Simmonds, England

This is a great idea. Having worked in Belgium for a few months and needed to visit the Doctor on a number of occasions, I found it was much better to pay a fee direct to the doctor. I walked in during opening times and was guaranteed to see the doctor every time. I think the fee reduces the amount of time wasters in the waiting rooms and the Doctors perform their job with a little more care. It gets very annoying here when you almost feel you need to plan in an illness to ensure that I can get an appointment when I really need it.
TC Gill, UK

If people had to pay and a doctor's income were dependent upon the quality of service then maybe we would get some professional and courteous service

Mark Lisle, Germany
As a consultant who has worked in Germany, Belgium and Ireland I have often found that a need to visit the doctor means having to pay a fee. However GP's do tend to be a little more professional and more accountable for mistakes and failures. The question is value for money, I find going to the doctor in the UK tedious since you have to run the gauntlet of a fierce secretary, later than planned appointments and very often shoddy diagnosis. If people had to pay and a doctor's income were dependent upon the quality of service then maybe we would get some professional and courteous service.
Mark Lisle, Germany (UK citizen)

I would be happy to pay 10 if I were getting the appointment on the day I want, the time it suits me with the doctor I know. But not if this pushed the free visits away, creating endless queues (like NHS hospitals). We already pay National Insurance and taxes. Doctor's service is included in this price, is subsidised by all tax payers for the benefit of all
Ioannis Psomadakis, UK

How about I charge the doctor for loss of earnings for the appointments he doesn't keep with me? Every time I book a doctor's appointment, I am never seen any less than ten minutes later than the time I booked in for. When I was a temporary worker, this had a real impact on my earnings.
Helen Jenkins, Wales, UK

If the doctor can charge for a missed appointment, then I should be compensated for having to sit through my appointment time!
Eddie, USA

If they had to pay a small fee, many would no doubt use more common sense

Mike Brownstein,NYC, USA
I am a physician in the US and those people who have health plans that allow them visits without taking any money out of their pocket, come in for the silliest reasons. In doing so, they needlessly waste the time and money of the health care givers that should go to people with substantial problems. You would not believe how many parents will bring their child to the emergency room because the child vomited after a meal - at taxpayers' expense! If they had to pay a small fee, many would no doubt use more common sense.
Mike Brownstein, NYC, USA

I am self-employed. A visit to the doctor already costs me dearly in lost earnings, so why should I pay more?
Keith Wilson, UK

Last year I was residing in Dublin where you pay to visit your GP as a matter of course, even though all employees have private medical insurance.
Liam Flanagan, UK

Charge patients that don't show up for appointments. It may teach people to be more responsible the hard way, and will definitely bring some much-needed cash into the NHS.
Jasmine Guha, UK / USA

An across the board fee sounds like profiteering to me

P. Hewitt, UK
I think a 10 fee to see your doctor is the thin end of the wedge, which would inevitably rise in time once introduced. Dentists usually charge patients for missed appointments and I agree with doctors doing the same (including charging time wasters), but an across the board fee sounds like profiteering to me.
P. Hewitt, UK

I've been living in Argentina for five years and we have to pay a percentage of our wages to a "sort of" national health service. But we have to queue up at the health office for maybe an hour, pay $3 for a certificate which then authorises us to see the doctor. However, if one is paying a contribution to the national health service, then nobody should have to pay. If doctors are angry at people not turning up for their appointments, why not introduce a fine for "no shows". Fees will only prevent the not so well off from going to see their doctor when they are REALLY ill.
Pierre Stapley, Argentina (ex-pat from the UK)

I have to visit my doctor every 12 weeks for an implant to combat prostate cancer. Should I have to pay 40.00 a year? I don't think so!
A.C., Scotland

Yes there should be a charge that is refundable to certain groups

Kit, UK
Yes there should be a charge that is refundable to certain groups, it should be payable in advance and refunds should only occur if the patient attends. This will help to ensure that doctors are consulted when necessary, and reduce people making appointments and not attending, which wastes healthcare workers time.
Kit, UK

Only 10? Don't knock it! I have to pay $50 just to get in to see my doctor!
Trevor, USA

So long as I can claim each 10 back from my National Insurance I can't see a problem.
Paul Fitzgibbon, UK

If this country ever nationalises its healthcare, I would bet that innovation will quickly become a thing of the past

Phillip J Hubbell, USA
In my estimation there is no right to anything someone else must provide. I don't mind paying for a doctor. I imagine you get the service you pay for. If this country ever nationalises its healthcare, I would bet that innovation will quickly become a thing of the past.
Phillip J Hubbell, USA

While I'm sympathetic to overworked doctors, I can't help think that if this charge was introduced then at some point, somebody who really does need help is going to be put off going to their GP. It might sound over-dramatic, but someone, somewhere is going to die for the sake of 10. Now charging people who don't turn up for appointments, that's another matter entirely!

I already pay NI and Tax to pay for health services so why should we pay 10 on seeing the doctor? I can afford to pay but those who can't will just not go. It will lead to more home diagnosis and worse health for the poorer people in society. It will be like going back to Victorian times.
M Lane, UK

What, pay yet again for something I have already paid for time and time again? You must be joking. I already pay for it in so-called National Insurance. According to Tony Blair I am also paying for it in extortionate gasoline duty! What about VAT at 17.5%? Council tax? Road fund licence? Duty on beer and wine etc.... need I go on? As far as I am concerned you can whistle for it. Got the telephone number of the nearest U.S Embassy?
Bill S., England

Either we have a free National Health Service, or we have a private system - lets stop mixing the two

Matt A, UK
Come On! We already pay through National Insurance, Fuel Tax etc for free medical care at point of contact - i.e. hospital emergency wards and doctors surgery. Putting the possibility of a fine or even a flat charge for an appointment has to be the most callous solution you can imagine. Either we have a free National Health Service, or we have a private system - lets stop mixing the two. As for unreliable appointees, then surely doctors and their support staff can quickly recognise this as a problem and then try to educate that person. I cannot believe anyone would ever want to be seen by a doctor unless they were unwell or uninformed.
Matt A, UK

Why should I have to pay 10 every time I want to see my doctor? I pay a large fee of my wages in National Insurance already. Can't there be some kind of penalty for time wasters, without penalising those who really need medical advice? It is stupid. The NHS is supposed to be free, yet with prescription charges going up all the time and now this, I might as well go private.
Caroline, London, England

You are made to feel like naughty children even when you turn up to the appointment as arranged

Les Moody, UK
Administering fee paying for appointments will create more overheads/disputes and will generate resentment from people who already feel that they do not get value for money from the NHS. Also, I resent being presented with facts and figures about missed appointments when sitting waiting for an appointment at the health centre. Absolutely no information is given about appointments delayed/cancelled by the surgery itself. You are made to feel like naughty children even when you turn up to the appointment as arranged. Largely speaking the atmosphere at the health centre makes you feel like you are a nuisance rather than a customer.
Les Moody, UK

Keep the NHS free. After emigrating to a country where you pay for all your health care, you realise just how much it does cost, especially when you have a family
Mark Colley, Australia

It always makes me laugh that you British put up with so much. You already pay NI which is supposed to pay for this and now your own government proposes to make you pay again!!!
Krishan Holedeep, Ireland

If hospitals can't even manage an appointment list they don't deserve compensation when people don't show up

J, England
Fairly recently my mother discovered she was unable to attend an appointment at a local hospital. She called them about two weeks beforehand to say she would not be attending, and rescheduled her appointment. When she arrived for her new appointment she was criticised for not turning up for the previous one! If hospitals can't even manage an appointment list they don't deserve compensation when people don't show up.
J, England

There has always been a group of doctors who wanted to destroy the NHS as a service, free at the point of use. The problem now is the lack of doctors - often directly due to the fact that it is horrendously expensive to get training and very lucrative to then supply your services to the private sector who haven't had to pay anything for that training! People who want to eliminate time-wasters should look at other ways. Remember that prescription charges were introduced at a minimal rate and now cost far more than many of the drugs prescribed. We need no more attacks on our 'free' health service!
Nick Gunning, UK

I have worked as a practising GP for the last 35 years

Dr. Grammer, Wales
I have worked as a practising GP for the last 35 years. Many people simply make an appointment and all they want is a little chat. I end of wasting at least 1 hour a day on patients who are perfectly healthy. We need to educate the general public more about health so that they can make a decision as to when it is necessary to visit their GP.
Dr. Grammer, Wales

Oh I get such satisfaction seeing the 's removed from my wages each month going towards my NI contributions!
Mark, UK

I believe that 10 is a good idea. It will make people wake up to their responsibilities instead of always saying that it is not their fault that they couldn't make it. Also, I believe that there should be a refundable 10 deposit for equipment given to patients. Equipment such as crutches, neck braces, muscle protection etc. You will be amazed how much of this equipment is NEVER returned to the hospital that issued it.
Roshan, UK

I have read many of the comments with interest. Those who wish to criticise GPs' performances should remember that the countries that they choose to make comparisons with, such as France or Germany, have considerably more doctors per head of population than are available in the UK. GPs and hospital doctors are very overburdened, and at some point this has to have an effect on standards. We have seen nurses become demoralised and leave the NHS in droves. The same will happen with doctors in the near future if conditions are not improved. If charging 10 will make people stop and think before seeing their GP, then all well and good. It's about time the public and politicians woke up and realised that there is no such thing as a free lunch. At some point quality healthcare has to be paid for.
Mark, London

I worked in a pharmacy until last week, and many of our patients are covered under the state health plan. They often receive health care the average working citizen could not afford. We filled a prescription for a woman who said she wasn't taking the medicine anymore. But she was perfectly willing to take the prescription (for free, of course), and then throw it away. Paying a nominal fee might actually encourage responsibility in some people who otherwise abuse the healthcare services.
Jessica, USA

I went to the doctors in the UK last week. Surgery was packed, hadn't seen a lick of paint for 20 years, I didn't see the doctor until over an hour after my appointment time and got given the usual antibiotics. Here in Germany I walk into the doctors, get seen immediately without an appointment, the waiting room isn't packed out with people and I have never been given antibiotics. But you get what you pay for. In Germany people pay far more for their health service and have far higher standards as a result. No GP's here, there's a collection of specialised doctors in every little village.
Ian, Germany

The UK citizen coughs up enough through taxes for the NHS already!

Mark M. Newdick, USA/UK
If you make an appointment and then don't turn up, then yes, you should pay a nominal penalty. Otherwise, the UK citizen coughs up enough through taxes for the NHS already! A more efficient use of current NHS funding would also be appropriate ... finding new ways to generate revenue is a poor excuse for reform!
Mark M. Newdick, USA/UK

How about a 10 deposit, returned when you keep the appointment or cancel at sufficient notice?
Pablo McBread, UK

If I only had to pay 10 to see a doctor here in France I would be laughing. However, it is worth it. The system here in France is excellent in both doctor's surgeries and the hospitals. The waiting times are minimal and the quality of health care is, in my opinion, second-to-none.
Matt, France, ex UK

Last time I went to the doctor (August 1997) she took one look at me, gabbled something unintelligible and practically threw a prescription at me. In and out in less than 5 minutes. Should I really pay 10 for that, on top of the 5.75 the prescription cost me? I knew what I needed, but the pharmacist wouldn't sell it to me without a prescription!
John S, UK

10 a visit may not seem a lot to some, but for the poorer people amongst us (and I don't necessarily mean the unemployed for which the fee would be waived anyway no doubt) it is a substantial proportion of their weekly income. It might deter time wasters - but it might also deter poorer people from seeking medical help when they genuinely need it.
Alison, England

Perhaps people would be more likely to pay if the doctors were more competent in the first place.

Craig B, UK
I would pay 10 if the service was good. My mother recently came out of hospital with an infection. The doctor prescribed 3 different antibiotics (all to no effect) before admitting that it should be other ones he should had given. A friend of mine also had their doctor miss their cancer several times (despite many scans and tests). Perhaps people would be more likely to pay if the doctors were more competent in the first place.
Craig B, UK

My [private] GP already charges me for visit - but it's a small price to pay for same-day service, a choice of times to visit, and no sense that he wants me out of the surgery as soon as possible so he can get to the next patient in the queue. I believe we should adopt the model which quite a few European countries use, where you are charged for GP and hospital visits, but then your insurance pays you back after the event.
Pete Morgan-Lucas, Wiltshire, UK

When free prescriptions are made available to those on benefits the number of prescriptions for basic painkillers increases, as these people with nothing better to do can use up the doctor's time to request something free rather than pay a couple of quid for it at Boots. If a nominal fee were introduced it would discourage this kind of time-wasting and allow people to get to a doctor when they need to, rather than when the doctor has finished with the plethora of trivial cases.
Nigel, England

Scrap the appointment system. It's useless anyway. I could never get to see my Doctor within 48 hours unless I could convince the receptionist I was seriously ill. If people could turn up and queue then they would see their Doctor as needed. This system works very well in France and French people accept that a lengthy wait is par for the course. Malingerers and habitual "no shows" don't exist.
Tim, France

"Stop being such a cissy, get out of bed and go to work, pull your socks up, stop whining you big girl's blouse!" - Ah the good old days!

Steve, England
Not many years ago it was seen as almost wimpish to visit the doctor for minor ailments. Now though, fuelled by the nation's apparently insatiable appetite for the latest health scares, we are urged to go at the drop of a hat. If the Nanny State insists on wrapping us all up with cotton wool it should expect to have to pay for it from its own coffers. Or how about a dose of healthy disregard for those aches and pains that are just a part of everyday life? "Stop being such a cissy, get out of bed and go to work, pull your socks up, stop whining you big girl's blouse!" - Ah the good old days!
Steve, England

Now having moved overseas to Singapore I'm impressed with the system here. GP's are essentially private but closely monitored. Standard consultation fees would be about 5 or 10 pounds including medicines. Usual these costs are reimbursed by most employers. Waiting time is usually 5 or 10 minutes - it's a walk-in system. Should you have to be seen at a hospital these is a system of payment based around a Medisave fund which all employed persons pay into over there working life.
The system isn't perfect and I still think that poor or uncovered individuals could miss out on treatment but it seems like a step in the right direction.
Gordon, Singapore, ex UK

I'm not sure about 10 being charged for visits to the GP but a charge should definitely be imposed on the hypochondriacs and drunken yobs that typically frequent many hospital A and E units and abuse or assault the staff.
A. Cutelli, UK

In Canada, most doctors and dentists have a policy of charging $20 (10) for missed appointments, but it's frequently waived on compassionate grounds etc. The policy is usually posted in big print at Reception, and mostly serves as a disincentive to no-shows.
Andrea John, Canada

Pay 10 for less than 10 minutes advice?

Zoe, UK
Pay 10 for less than 10 minutes advice? This would effectively make the GP's rate in excess of 60 per hour! Many appointments end with the doctor writing a prescription - this adds a further cost of 6, making illness an even more expensive and stressful burden than it is already.
Zoe, UK

If this comes about then I want a refund or reduction in National Insurance.
Andy, UK

Rather than charge everyone 10 for each appointment to reduce non attendance, why not charge that amount to those who have not turned up? I know that I am not a rocket scientist but it seems to make sense?
Ian Bailey, England

It is already outrageous to have to pay to see a dentist. I expect the outcome will be the same with doctors - people will not visit. I have not seen a dentist for years as I object to paying 20 for someone to say "Keep up the good work Mr. Cowdery". Whatever happened to free healthcare?
Chris Cowdery, UK

There is very little incentive for doctors or their administrative staff to treat patients with respect. A fee-paying system which included more freedom of movement between surgeries would have to be a good thing, encouraging patients to demand more of their relationship with their doctor. As long as there were exemptions for poorer people, it would not be a bad thing.
Andrew Oxenburgh, UK

Free health care is one of the things which Britain can still be proud of, and we certainly shouldn't be discouraging people from checking out symptoms of potentially serious diseases.
Liz, Japan (UK)

There should be a charge of some form for ALL medical care

John B, UK
There should be a charge of some form for ALL medical care. When I was unemployed I would accept a prescription that made life easier, even if I didn't strictly need it. Had I had to pay for it (as I now do) I would have thought twice. It is the patients that claim to be unable to afford it that are most likely to have time to take the liberty to not show up. If someone decides they can't afford the fee because they spent all their money on cigarettes they have set their own priorities and should face the consequences.
John B, UK

Early detection of illness often results in simpler, cheaper treatment. Charges will deter people from seeking help until conditions have worsened and the treatment becomes more expensive. As a means of reducing missed appointments, charging patients is a very shortsighted solution
Eileen, UK

In a word yes. Anything free nowadays will be abused by the users. It might also mean that we could have an appointment when one is actually in need of it rather than two weeks later.
Tim Wood, UK

A set fee would soon result in longer consultations and longer waiting times as both doctors and patients strive for value for money. For a fun packed afternoon, try sitting in a French doctor's waiting room and you'll find very few patients spend less than half an hour with the doctor.
Steve, UK

The quality of most NHS GPs is so low that 10 is too much.

What have we paid our National Insurance for? It would be cheaper for us to take out our own private cover and get better service. As it is, with lots of doctors you have to make an appointment about three weeks in advance, and we don't always know when we are going to be sick.
Lynda Geraghty, UK

Last winter when our hospitals were overflowing, much talk was made of how "the French manage to cope". What wasn't mentioned was the fact that the French pay for their doctor's appointments at point of service, thus giving much needed extra revenue to their health service. Most working people could afford to pay perhaps 5 for their appointments; those on benefits of any kind would obviously not have to. I don't see much wrong with this proposed system. In my doctor's surgery there is a notice of how many people failed to attend in the previous month - usually it's at least 100. They should definitely pay!
Tricia, UK

Removal of student grants, introduction of tuition fees and now 10 to see the doctor. So when are we paying citizens going to see tax cuts? Or are we paying twice for everything now??
Neil Lees, UK

Is this scheme going to be applied to hospitals as well?

Jez, UK
Is this scheme going to be applied to hospitals as well? A and E depts are always full of minor cases, and people who haven't bothered to register with a GP? What about waste of time 999 calls for people who call up because they need an aspirin, or have run out of tampons?
Jez, UK

I think the system for obtaining appointments is bad enough without putting up new barriers. I commute daily to London, work long hours and have to resort to taking time off work to visit my GP as surgery hours are only available while I am at work and there is no weekend surgery. Why not charge people who miss an appointment rather than force everyone else to pay instead. If they persistently miss appointments, they could always be refused them in future or charged an even bigger fine.
Tanya Ramsden, UK

I know what, I'll go into competition with my GP and only charge people 5 a go to be told to take some aspirin, go to bed and stop bothering me.
Peter, UK

Introducing a charge for a doctor's appointment would be a further step towards the privatisation of the health service

Eileen George, UK
Introducing a charge for a doctor's appointment would be a further step towards the privatisation of the health service. We have seen that the removal of optical and dental services from NHS provision has led to the low paid worker and those on benefits going without. The same will happen if charges are levied for visits to the doctor. My parents' generation never called in the doctor unless they were at death's door due to fear of the costs. Are we going back to those not so good old days? The right to medical advice should not be compromised by the patient's lack of financial resources. At my own GP's surgery, it is difficult to get an appointment (except in the case of an emergency) inside two weeks. We need more GPs not back door rationing.
Eileen George, UK

What about those medications where it is necessary to have regular check-ups? For example, the contraceptive pill is currently free, but since it cannot be put on repeat prescription charging for appointments would essentially raise the cost to ten pounds per prescription! What about call-outs? Charge across the board for them as well? It might dissuade people from abusing the service, but it might also dissuade the people who actually need it.
Sarah Blake, UK

If the majority of the population actually ate properly, exercised and stopped spending the night on the couch watching mind numbing TV programmes then perhaps they would not need to visit their doctor. Good health comes from within, not from a prescription from the doc. Instead of visiting the doctor to let them know you feel lethargic, get out and go for a long walk, drink and eat properly and learn to relax. It's not the doctor's fault we can't look after ourselves.
Dave, UK

To charge for every visit would be wrong. Each person should have an annual allowance of free visits, say 6 new consultations per year. After that follow-ups and children's appointments can be free.

Yes, I think it is a good idea or at least something similar to our system in Belgium. You pay the doctor FB580 (8.90 pounds) and are later reimbursed FB380 (5.85 pounds) by the national insurance. This would take some pressure off the Government's support of the National Health or would allow those taxes to be better used for shortening waiting lists etc (which we do not have over here). If there are families with real financial problems they could be exempted from payments.
Margaret Carre, Belgium

Will the next step be medical insurance like the States?

Jay, UK
One of the benefits of this country is its National Health Service. Charging people to visit their GP makes a mockery of this service paid for by our taxes. Will the next step be medical insurance like the States? Let's hope not!
Jay, UK

If my appointment with my GP was on time (never has been) I may consider paying the 10. To pay this and see no improvement in service would probably be the outcome
John, UK

Who has the time to visit the doctor for "frivolous" reasons? I suspect that it is the very people who wouldn't have to pay anyway - those who are out of work. The proposed 10 charge would effectively prevent hardworking families from consulting the doctor at all until desperate. This could result in vital treatment being delayed.
Caroline Brown, UK

I cannot believe this will be implemented. It seems hard to imagine that GP practices don't know which patients are unreliable or late for appointments. Perhaps like the dentist they should make a charge for this reason. I cannot see why the majority should have to pay for the thoughtlessness of the minority.
Chris, UK

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21 Aug 00 | Health
Support grows for 10 GP charge
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