Select Committee on Health Written Evidence

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 remain free.

  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 be investigated.

  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 the charges.

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 ensure equality.

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

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