Rethinking primary care user fees: is charging a fee for appointments a solution to NHS underfunding?

Could a fee for primary care appointments alleviate health services funding pressures and primary care workload? This editorial examines the lessons learnt in other high-income countries regarding intended and unintended consequences of primary care user charges.

Debates over user fees in the NHS are not new. In 1951, Hugh Gaitskell, then Minister of Treasury, introduced charges for prescriptions, spectacles, and dentures in the NHS. Aneurin Bevan, Minister for Labour and architect of the NHS, resigned in protest at this abandonment of the principle of care free at the point of need.

Sixty-seven years later, on the 70th anniversary of the NHS, the debate on user fees is timelier than ever. In 2016, the NHS in England saw the largest aggregate deficit in its history, at £1.85 billion, with a projected £30 billion funding gap by 2020. Capital spending is projected to be reduced by 9% in real terms from 2015–2016 to 2020–2021¹ and is projected to fall to 6.8% of GDP by 2020,² putting the UK in the lowest quartile among Organisation for Economic Co-operation and Development (OECD) countries. Demand for NHS primary care continues to increase, and GPs in England are now busier than 10 years ago. The growing mismatch between supply and demand raises concerns whether the historical concept of a free cradle-to-grave NHS is still achievable. The additional £20 billion indicated by the prime minister in June is a critical aid, yet sustainable solutions are needed to ensure the NHS balances supply and demand in the long term.

One proposed solution is introduction of user fees for primary care services. Many highly developed countries charge users to access primary care, commonly through a flat-rate co-payment. The Reform think-tank has suggested a £10 fee for primary care appointments, which could …