Patients should pay up to £20 to see a GP to keep the cash-strapped NHS going, a think tank has said.
The Social Market Foundation (SMF) argues that a charge would make people think twice about visiting the doctor, cutting unnecessary appointments and easing pressure on the health service.
The independent think tank, which includes finance experts and MPs from different parties, made the controversial proposals in a new report.
It said that only the poorest should be entitled to free treatment and called for prescription charges to be introduced for all pensioners. The £7.20 prescription fee paid by most patients for most drugs is currently waived for the over-60s.
The think tank said that such "rationing" of treatment is needed to ensure that the NHS survives the economic downturn.
The SMF's policy advisory panel includes cabinet minister Liam Byrne, Liberal Democrat MP Vince Cable and ex-Scottish Labour Party leader Wendy Alexander.
It said that fees to see a GP would not breach the values of the NHS as people already pay to visit the dentist and for prescriptions.
Report author David Furness said: "It would get people thinking twice about whether the visit was essential.
"If we don't introduce rationing like this, there will be rationing by stealth through waiting lists, crumbling hospitals and poor-quality services."
Copyright © Press Association 2009
Your comments (terms and conditions apply):
"Why do I pay my taxes? Don't they contribute to helping run the NHS? Charge all those who DNA appointments!!!" - Name and address supplied
"To maximise efficiency I suggest a charge for all DNAs. Hopefully this will avoid penalising the lower socio-economic groups unfairly. Any attempts to means test payments for consultations just ends in more bureaucracy" - Kiran, West Midlands
"Why not? But in the interest of choice there should be an online option input symptoms get diagnosis. Then issue script number and save need to bother GP at all. I am curious, does the think tank also advise regular checks carried out by nurse/GP should also include a fee? I feel the uptake of chronic disease management may fall off." - Margaret Shannon, Willesden
"Yes if people are on a certain income." - Name and address supplied
"I think this suggestion is an excellent idea. A new initiative which will contribute immensely to the NHS and reduce failed appts, encourage patient self health assessment, decrease health abuse and allow for informed choices and better care delivery" - V Henry, London
"Having lived in Belgium and Italy prior to moving to the UK, I have seen the benefits of paying for treatment. I agree that patients should pay to see their doctor. In Belgium, however, you have reduced fees or free if you are an orphan, widow, pensioner or invalid or out of work. This means the access is not denied to people with reduced means. I am sure this would reduce the DNAs for both nurse and doctors appointments" - Caroline Flasse, Maidstone, Kent
"I don't see an issue with paying to see your GP, but unfortunately the majority of those who abuse the system are those who wouldn't have to pay. This would then be the scenario of the workers having to pay for those who don't work. The best comparison is with dental care, when you have to pay then you don't attend - look at the state of their teeth. When dental care is free the waiting times are huge. So why should those who want to work have to pay for those who don't want to work." - J L Allen, Scotland
"The problem with this idea is that the majority of the work generated in the NHS is by those people in lower socio-economic groups, who would be exempt from charges anyway. The way forward has to involve charging all users of the service. A flat rate of prescription charge (£1 per item) for all POMs, and the abolishment of free prescriptions across the board would be much more sensible. Coupled with all GSL and P medicines having to be paid for by the patient would prevent people abusing the system." - Lynne, Lancashire
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