The founding principles of the NHS in 1948 were that the service should help everyone and be free at the point of care, based on need rather than ability to pay. While nobody would argue that the NHS isn’t now in crisis, few in healthcare policy suggest charging as the remedy, as Sajid Javid has (Mark my words: this will be the end of the NHS if the Tories have their way, 23 January).
Monetising the NHS at the point of care would have consequences. Many patients would simply not seek help, negatively impacting their long-term health – and hence the economy, the wider NHS and social care too. Charges would further widen health inequalities (a study showed that after healthcare charges were implemented in Ireland, those on low and middle incomes were five times more likely than better-off patients to forgo a GP appointment).
Doctors asking patients to return for routine checkups may be branded money-making rather than caring. Ethical dilemmas would arise where patients in need could not meet fees.
Extra staff will be required to collect and police any payments. And just imagine the anger and comments that would be directed towards frontline NHS staff on a daily basis – further eroding morale and distracting us from direct patient care.
Dr Ellen Welch Co-chair, Doctors’ Association UK
Dr Lizzie Toberty GP lead, Doctors’ Association UK