Why not charge for not having an appointment?

British nurses are planning to debate whether GPs should start charging patients for appointments.

The Royal College of Nursing’s (RCN) annual conference in Liverpool will discuss whether the union backs the idea of charging people a fee to see their family doctors.

Traditionally the RCN has stood behind the belief that the NHS should be free at the point of delivery. But nurses have put forward the motion, saying that NHS finances are “not infinite”.

Andy McGovern, a hospital nurse in London, said he would propose a motion calling for fixed fee to see a GP. Research suggested anything from 57p to £10, he told the Daily Mail. “We need to have a robust and honest debate about what we’re going to do in the future because the money isn’t there,” McGovern said.


There’s two
different things here.

One is trying to raise money. And charging for an appointment isn’t going to raise much. For the jobless, pensioners, the pregnant, children and so on aren’t going to get charged. So most of the people who actually use a GP won’t thereby raising little money.

However, we might well want to make sure that people do actually turn up for appointments they’ve made. Which means a charge for missing an appointment but not one for going to one.

23 comments on “Why not charge for not having an appointment?

  1. I’ve been saying this for a while; charge £20 for an appointment and refund it if the punter turns up.

  2. Surely it makes no difference to waiting lists/people turning up whether a charge is made or not.

    GPs already assume that 10% (or 30%) patients won’t turn up and so “over book” their daily appointments.

  3. Totally agree. My surgery has a list of monthly missed appointments on its notice board, so target them directly.
    Two strikes and you get taken off the list and a fine levied that has to be paid before a surgery will accept you.

  4. “before a surgery will accept you.”= the lawyers will like this. You collapse on the way to the appointmnent and end up in hospital instead and then , later , find you cannot get further treatment.

  5. Charging for missed appointments is crude, not necessarily effective, and we’d probably just see the same list of exceptions that Tim already gave.

    The airline & hotel sectors have developed two solutions:
    1: Overbooking
    2: Stand-by passengers

    Any sensible medical practice will already be using both techniques to maximise resource (GP) utilisation.

  6. Oh and we shouldn’t just charge for GPs because of public health. If a school dinner lady has TB, we’d quite like her to be treated as fast as possible, even if she’s only on minimum wage (and part-time at that). But she might not be prepared to shell out £££ to see a doctor because “it’s only a cough”. Hence a minimum level of free healthcare seems necessary.

  7. But nurses have put forward the motion, saying that NHS finances are “not infinite”.

    Non-nurses have been pointing this out for decades.

    There are a lot of countries which charge a nominal fee to see a GP in order to keep the hypochondriacs and time-wasters away. But if you suggest this to the Left, they’ll accuse you of wanting to copy the US healthcare system root and branch.

  8. Since I’ll be in the UK for a while, needed some medical treatment. Rang round several surgeries to see if they did private without success, thought I’d register at the local NHS GP. That was Wednesday. Was given a folder of forms to complete & told I could have an appointment the following Tuesday. Jumped the ferry to France on Thursday afternoon & got the problem sorted on Friday morning while I was there. Walk-in service. So I didn’t bother about keeping the appointment. Fuck ’em. It’s my convenience I’m interested in, not theirs.

  9. Or how about the German system of not bothering with appointments. If you need to see a doctor because there is bad stuff happenin you go to a doc and wait there. Appointments are for routine stuff.

  10. As BIS says, my family GP had a walk in clininc every evenings, on a 1st come 1st serve basis. Worked very well.

    That said, the idea of charging for missing appointments would work for things like nuclear medicine scans, where the dose of nuclear material is prepared for the particular person, and decays within a day. So the doses are prepared every day, and thrown away if not used. The cost runs into millions over the NHS.

    Funnily enough, my wife ran a private nuclear medicine clinic, and they had only 1 missed appointment over 2 years. Something to do with the fact that the secretary was also in charge of calling people to remind them…not rocket science you would have thought. But for the NHS it is.

  11. “Which means a charge for missing an appointment but not one for going to one.”

    If it’s 10 minutes before my appointment, and I call to cancel, do I pay? Or get it free? What if I’ve remembered my appointment an hour before, but feel better? Am I going to turn up, sit there and say “actually, I feel better” just to avoid the bill if they stick a 24 hour notice clause in there.

    As Shinsei1967 points out – there’s already a built in factor about missed appointments, and in my experience, I never see my GP at the allotted time. Missed appointments are largely irrelevant if factored for – all we actually care about is if a GP is twiddling his thumbs because he has no patients.

    I suspect the whole missed appointment thing is designed to deflect attention away from the inefficiencies of the NHS, to make it look like it’s us, the patients that are the problem.

  12. “a charge for missing an appointment”: my experience includes

    (i) The NHS sending me a rude where-the-hell-were-you note when they had failed to tell me about the appointment
    (ii) Spending a whole day in hospital undergoing unpleasant prep for a procedure only for them to call it off in the late afternoon because someone hadn’t shown up for work first thing in the morning
    (iii) The NHS giving me two different appointments for the same time and date and then insisting that I was cancelling one of them, rather than accepting that the folly was theirs.

    I wouldn’t trust the sods with a failure-to-turn-up tax, especially as they would then run things to maximise that income.

  13. I would like a system where I am able to charge the NHS for not making any appointments with them at all for the last 35 years. I must have saved them a considerable amount of money over the average malingering hypochondriac

  14. From my limited experience of GP surgeries, the people in there all day every day would be exempt, I imagine. It would raise fuck all.

    Funny how calling for any sort of NHS charging makes you the devil incarnate until some part of the NHS suggests it, and suddenly it’s a spiffing idea whose time has surely come.

    Anyway, 57p, LOL.

  15. I’m getting fed up of all these areas where I have to pay for something to be set up in a very inefficient way and then a continual charge for its inefficient running costs and then being charged for using the crap service they provide..

  16. Lord T calls it.

    Why do people argue about this kind of obvious smokescreen nonsense?. The issue is not to charge or not. The issue is what happens to the tens of thousands of millions of pounds the bastards get each year and they still can’t provide a service properly?. If they can’t make it work after getting a colossal fortune handed to them each and every year–then shut it down.

  17. dearieme is spot on. I’ve seen all three of those myself.

    Could I charge doctors when they cancel appointments? Or would this be a one-way thing for some reason?

  18. insurance based systems like France have this down pat – pay £10 up front for an appointment, if you turn up you get reimbursed by the insurer, if you don’t (without good reason) then you can go whistle

  19. Germany – nominal EUR10.- fee to see a GP. Reduced the timewasters overnight.

    I live in CH now – I have to pay full price to see a GP for illness (CHF35.- for a 10 minute consult in hours, 190.- out of hours) unless it’s for an accident (different insurance regimes, you see). Guess what? Nobody f*cks around going to the GP for a cold. Heck, they used to give amoxycillin in the UK for that when I was a nipper – waste of money and contributed to antibiotic resistance. Great job, Envy of the World….

  20. Part of the problem may be the shocking way that appointments are granted (and always feels like a favour).

    You can either ring, if you have massive patience, or go and queue for an appointment. Always good for the genuinely ill, the pregnant, infirm and so on. Hospital appointments, of course, are just random, prone to being cancelled, blah blah. The system in both cases is as demeaning as it is screecingly inefficient.

    The dentist on the other hand, who has heard of mobiles and e-mail, sends reminders and can take the moral high ground with wasters.

    The dentist, however, is only so-so in comparison to the vet: if you need to, you just turn-up. If it’s routine, you make a quick call and arrange a convenient time.

    It can’t be a coincidence that the service provided follows the same pattern. Half the GP’s I’ve come across are malingering, uninterested twats themselves.

  21. when I worked in a small company we outgrew the number of free car parking spaces and there was a lot of tension about who should ‘own’ one. We decided the best thing was to rent some more spaces from the landlord and charge everyone a modest amount. Even though it was only a fiver (and these people were in financial services so not exactly poor) the excess demand largely disappeared overnight. If you want someone to value something you need to put a price on it, however small. I would personally index it to the equivalent of one packet of cigarettes.

  22. As an American ignorant of the NHS, I thought the whole point of the NHS was that it was all paid for through taxes. As LordT and Mr. Ecks said, then, why charge for appointments? Charging for appointments with a GP seems like a failure of the NHS model. So if charging appointments is the thing to do, why not go further and get the NHS out of it, going over to a private, free market system entirely? Would that be unBritish?

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