The new NHS reality

When Aneurin Bevan set up the NHS all the way back in 1948, he probably didn’t expect the phrase “free at the point of use” to be quite the British health mantra it is today. But then again, he probably also wouldn’t have expected the population to be somewhere around the 70 million mark or for average life expectancy to be in excess of 70.

Free at the point of use has been the cornerstone of the health service for nearly seven decades. More than that, it’s been elevated almost to the point of national pride that if you get sick or injured, you can see a GP or be admitted to hospital. No ifs or buts, no interminable insurance forms to fill out. You need care, you get care.

Because we’ve elevated the ‘free healthcare’ of the NHS to such levels (Nigel Lawson famously suggested the the NHS was the nearest thing the English had to a religion), the very suggestion of charging for anything health related is major news, if not stapled to the front page. Even though it’s a bit of a myth – we pay for prescriptions and eye tests after all.

So, inevitably, suggestions that a growing number of GPs are in favour of charging for appointments is major news. Frankly, however, we shouldn’t be surprised by the suggestion – and while there are good reasons not to go down that road – it’s not something that can be immediately dismissed out of hand.

Primary care has always been the poor cousin of hospitals. Before the 2015 General Election, GP leaders were crying out for more money, citing that not even ten percent of the health service’s annual budget was directed their way. The demands on the NHS, and on GPs, have only grown since then. Ministers are pushing for surgeries to be open seven days a week, and doctors each have hundreds but more likely thousands of patients on their books. Many GP practices across England are not fit for the purpose of providing week-day care, let alone extended seven day services, with the NHS capital budget having been raided consistently to plug gaps in emergency services over the past few years.

The argument in favour of charging for GP appointments, as The Times succinctly put it, is that provide the financial resources needed to offer more appointments, while helping to fund training for more GPs to address a chronic shortfall and providing a disincentive to patients who miss their appointments. It could also help to ensure that care is delivered in fit-for-purpose, close to home facilities that will increase patients’ wellbeing across the board. The primary argument against is that could impact low-income families.

Ministers will be loathed to consider, let alone agree, to charging for GP appointments. Doing so violates a central tenet of the NHS and could cost votes. But the issue even being on the table is symptomatic of the hard choices ministers will have to make when it comes to health policy during this parliament. Theresa May has strongly suggested there won’t be more money for the NHS beyond what was set out in the Five Year Forward View. Indeed, simply pouring money into the NHS is no long-term solution. But at the same time, every financial analysis of the NHS going shows it’s on its knees financially, while ministers continue to push for a seven day service.

There are pros and cons to charging for GP appointments. Like it or lump it though, it demonstrates the new reality of the NHS, one that’s not going away and that might mean ministers can’t have both deny significant additional funding and want doors open seven days a week.