25 February 2000
This further erosion of Aneurin Bevan's vision of an NHS that gives treatment free at the point of delivery is proposed in a new British Medical Association discussion document.
Shaping Tomorrow includes interviews with 100 health service commentators such as doctors, managers and patient representatives, and is designed to stimulate debate about the future of GP services in advance of a conference in Harrogate next month. Prime Minister Tony Blair will answer questions via a video link at the conference and Health Secretary Alan Milburn will give the keynote speech.
Many of the GPs interviewed for the report claim the NHS can no longer afford free consultations and that means-tested charges should be introduced.
Brian Goss, a former member of the BMA's GP negotiating team, said most patients only need five GP visits a year. He said £250 a year was affordable for many people, though more seriously ill patients could be treated free, regardless of their circumstances. 'The cost is half of a continental holiday. Someone who consults more than ten to 15 times is getting pretty ill and will fall out of private provision into the NHS,' he added.
He said such a move would mean rewriting the family doctors' fees bible, The Red Book, which prohibits a GP giving NHS and private care to the same patient.
Other commentators also predict a move away from this rigid method of paying GPs. Chris Ham of the Health Services Management Centre at Birmingham University, suggested that primary care groups may be the catalyst for this change.
PCGs could encourage greater flexibility in local commissioning and variations in fees. For example, nurses could carry out initial consultations, enabling GPs to double the number of patients on their practice list. This would make primary care more efficient and increase GPs' pay, Ham said.
The NHS Confederation said the document was a useful contribution to the debate on primary care. It said that looking at GP services in isolation was outdated.
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