Should we charge for A&E?

I recently spent 3 weeks in Florence, Italy, in an emergency department at the regional trauma centre where, within a triage system of red, yellow, green, and white: white cases are non-urgent primary care complaints such as coughs, constipation, and earache. Patients over 14 years of age in this category are charged €25 when they have been seen, to discourage patients with non-urgent conditions, encouraging them to seek advice from their GP instead, and recouping the costs of unnecessary attendances.

With A&E attendances in the spotlight and NHS budget constraints such a topic of public debate, are we on the way to charging for some services? Would a charge for unnecessary attendances help to relieve pressure on A&E departments or would it discourage patients from seeking help and put them at risk of harm? Would this just increase GP workload even more? Could it be that patient education, instead of charging, is the way to reduce unnecessary attendances? Are charges of this kind becoming inevitable in the NHS?

• © British Journal of General Practice 2013