Memorandum submitted by the Royal College
of General Practitioners (CP 7)
1. The College welcomes the opportunity
to comment on House of Commons Health Committee: Inquiry into
Co-Payments and charges in the NHS.
2. The Royal College of General Practitioners
is the largest membership organisation in the United Kingdom solely
for GPs. It aims to encourage and maintain the highest standards
of general medical practice and to act as the "voice"
of GPs on issues concerned with education; training; research;
and clinical standards. Founded in 1952, the RCGP has over 23,000
members who are committed to improving patient care, developing
their own skills and promoting general practice as a discipline.
3. The College supports a review of co-payments
and offers the following comments for your consideration.
Are the charges for: treatments, including prescriptions,
dentistry and optical services (such as telephone and TV use and
car parking) equitable and appropriate?
4. In general the College feels that any
form of co-payment or charge is likely to be more regressive than
a system that is free but paid for by taxation.
5. The College is concerned that some prescription
charges are not equitable. The College feels that some individual
diseases gain exemption when they are no more serious or requiring
of long term management than others. For example a patient who
suffers from hypothyroidism will receive exemption from all prescription
charges, where as a patient who suffers from hypertension will
have to pay for everything.
6. Further more the College is concerned
that some exemptions from prescription charging are irrational.
For instance if a patient has one of the index conditions then
they will receive free prescriptions for any condition. However
it is only necessary for the patient to start on the index to
allow life time exception. Even if treatment is stopped at some
stage, treatment for all other conditions for this patient will
7. The College feels that there should be
charges for telephones to take into account the cost of premium
numbers. However given that mobile phones are not supposed to
be used in hospitals, perhaps the NHS could investigate a system
whereby NHS phone lines could be connected to a cheap (or even
free) service to reduce costs to patients.
8. The College further feels that an area
in the hospital where it is permissible to use mobile phones should
be investigated. However for those that are bed bound this would
not be an option and therefore the former option should still
9. In regards to hospital parking the College
feels that there are cases for and against charging. For instance
charging would encourage people to exercise more if they lived
close by as well as cutting down on carbon emissions. It would
also discourage those not on hospital businesses from parking.
10. However on the other side it would be
unfair to charge those who have no option but to travel by car.
The College would also be concerned that if parking charges were
high it would encourage more people to ask for ambulance transport.
This would mean GPs would have to make more decisions as to who
should and shouldn't receive ambulance transport and this is already
a difficult and unwelcome job. The College suggests that exemption
for those being admitted to or attending out-patients would help
to resolve this.
What is the optimal level for charges?
11. There is a concern that in some cases
young adults and the elderly avoid eye and dental checks due to
Is the system of charges sufficiently transparent?
12. The College is concerned that there
needs to be more transparency in co-payments and that there needs
to be a greater standardisation across the country in order to
What criteria determine who should pay and who
should be exempt?
13. The College is concerned and feels that
exemptions from charges in the NHS are not always equitable. Exemption
charges do not take into account wealth and the poor still have
to pay for dental and optical treatments. Further more some people
who do receive exemptions such as the over 60s may in fact be
relatively wealthy in comparison to working people.
14. The College feels that consideration
should be given to abolishing routine eye tests and dental examination
fees for full time students over the age of 18 and possibly even
to abolish prescription charges in this group as well given the
level of debt that most are now incurring. Abolishing these fees
may well prove to be cost effective in terms of long term benefits
both for patient and NHS treatment.
I acknowledge the contributions of Dr Claire
Gerada, Dr Orest Mulka, Ailsa Donnely and Professor Nigel Sparrow
towards the above comments. While contributing to this response,
it cannot be assumed that those named all necessarily agree with
all of the above comments.
Dr Maureen Baker
Royal College of General Practitioners
5 December 2005