Patient co-payments for general practice

I was pleased to see the taboo topic of patient co-payments being discussed, although it is interesting that the two health systems discussed were Antipodean destinations for emigrant GPs, rather than the many successful European health systems, including Holland and France, that include such payments.

We are missing something in the UK by not enabling patients to contribute towards the cost of accessing the front door of the NHS — GPs. The talk about access is admirable, but why not capture some of the benefit of this to patients and employees by allowing GPs to offer co-payments for extended hours, online pre-booking, and untriaged urgent appointments? It is wrong that a self-employed plasterer, for example, has to take time off to get an urgent appointment, but this is the reality of a stressed system with funding derived from one source only. Allowing this patient to book a timely yet convenient appointment with a co-payment is obviously beneficial, and can bring in more money than it costs to provide. Similarly, employers may offer to pay for this service for their employees. Bringing in more finances to NHS GP practices in this way would support, rather than undermine, free-at-the-point-of-use GP care for the population.

The oft-misused example of aeroplanes can be useful in this case. All those on a flight arrive at the same destination, captained by the same trained pilot, and equally safe, yet some pay more for convenience and facilities. Of course, if a plane is not going to be safe due to funding, equipment, and staff shortages the flight is cancelled; yet in a centrally-underfunded NHS we soldier on, despite the risks to patients and staff.

• © British Journal of General Practice 2015