NHS charging would be hard to run and raise only small sums, thinktank says

<span>Photograph: RayArt Graphics/Alamy</span>
Photograph: RayArt Graphics/Alamy

Charging patients for using NHS services would be hugely expensive and complicated to implement and would not banish the health service’s problems, a thinktank has found.

Several senior Conservative politicians have proposed introducing fees for accessing NHS care and Rishi Sunak has previously backed £10 fines for people who miss a GP or hospital appointment.

Liz Truss, who was prime minister for 49 days last year, previously co-wrote a pamphlet in 2009 that advocated requiring people to pay to see a GP.

However, the Institute for Government (IfG) has concluded that charges would be very difficult to administer, would raise only small sums for the NHS and would stop some patients seeking medical help. They would also be unpopular and make the NHS more “transactional”, it said.

In January, Sajid Javid, who was the health secretary from June 2021 to July 2022, said charges for GP appointments and A&E visits were needed and should be part of a “hard-headed conversation” about how to help the NHS cope with the intense pressures on it.

But the politically unaligned IfG’s new analysis has identified an array of challenges that any government wishing to bring in charges would face. The report’s author, Nicholas Timmins, found that so many people were likely to be exempt from new GP charges, and the system of collecting money would be so costly to run, that the revenue raised would make little difference to the NHS.

Even though a £10 charge would in theory generate £3.5bn a year, exemptions based on the same groups who do not pay prescription charges would reduce that sum to at most £400m, he said.

In addition, imposing a fee to see a GP surgery would force the government of the day to charge for attending A&E, to avoid people going there for free care for minor ailments.

Timmins concluded that advocates for NHS charges, which are also referred to as co-payments, had not answered the many practical questions that switching to such a system would involve. “Money is always helpful [to the NHS]. But on the evidence here, the sums raised are unlikely to be transformative and there is little public appetite for them,” he said.

Seven in 10 voters believe that NHS charges will creep in over the next decade, according to Health Foundation research published just before the NHS’s 75th birthday in July.

Sunak signalled last October that he had abandoned his support for £10 fines for failing to turn up to see a GP, after an outcry from medical groups. That was despite him saying just two months earlier that he planned to “get tough” on GP no-shows. Recent media reports have said he is considering reviving the idea.

Dr Victoria Tzortziou Brown, the vice-chair of the Royal College of GPs, said: “Charging patients for appointments will not work in any form. It will have the biggest impact on our most vulnerable patients and risks creating a two-tier system that favours those who can afford to pay and disadvantages patients who can’t. We simply cannot risk putting patients off visiting a GP when this is the care they need and deserve.”

Rightleaning thinktanks said charges were an idea worth considering. Dr Sean Phillips, the head of health and social care at Policy Exchange, said: “Expanding co-payments should be part of a conversation on how to sustainably finance health and care services.”

However, he added: “Charging for GP appointments may reduce demand but those in need are most likely to be deterred. Patients will resurface more unwell in the most expensive parts of the NHS.”

Kristian Niemietz, the head of political economy at the Institute of Economic Affairs, said he opposed Sunak’s idea of fining people who missed NHS appointments. But he backed charges for seeing a GP, visiting A&E or having an operation or outpatient appointment.

“Most healthcare systems use co-payments of some sort, even in egalitarian Scandinavia. There’s nothing unusual about them. It’s only in Britain that they’re such a taboo topic,” he said.

The Department of Health and Social Care said it had no plans to bring in any charges.

A spokesperson said: “The NHS will remain free at the point of use – that is one of its founding principles. There are no plans to introduce charges – such as for missed GP appointments – but we strongly encourage patients to attend as every appointment missed costs money which could be spent on patient care.”