Charging for GP visits would be a disaster for early diagnosis

By Frances Powrie June 18, 2014 9:29 am

The Royal College of Nursing will today debate a motion on charging patients up to £10 for a visit to their GP. It’s worth noting that the motion has been put forward for debate by members of the organisation, rather than forming official policy – and is unlikely to gain majority support.

Nevertheless, the motion raises an issue which has come up at a number of points in the current debate on how to meet the increasing cost pressures on the NHS. Some health care experts believe that charging patients would not only raise additional money for the NHS, but would also put off patients from going to see their GP over “trivial” issues.

Charging for GP visits has the potential to seriously hamper efforts to improve early diagnosis of cancer and other chronic conditions, with a significant impact on survival rates and quality of life for those patients. Many cancers – such as pancreatic cancer and ovarian cancer – initially present with symptoms which seem “trivial”. They are often confused with common, non-life threatening conditions such as indigestion, acid reflux or irritable bowel syndrome. Many patients have to visit their GP several times to get their concerns taken seriously and get the referral to secondary care which they need for a definitive diagnosis.

The problem is particularly acute for the less common cancers which often have vaguer symptoms – for pancreatic cancer, 42% of patients had to see their GP three or more times before being referred for investigation, compared to 25% for all cancer patients – according to the Department of Health’s 2010 National Cancer Patient Experience Survey. Many patients are initially told that their symptoms do not merit serious concern – and a charge for visits could put them off from making the repeat visits needed to get their concerns taken seriously.

With the Department of Health running campaigns such as Be Clear on Cancer to encourage people to check out worrying symptoms, it would be counterproductive to put in measures to discourage people from visiting their GP – and the impact would likely be greatest on people from lower socio-economic groups, who already suffer from worse health outcomes.

Work is also needed to ensure that GPs are able to spot serious symptoms sooner. Tools such as Macmillan’s cancer decision support tools could help GPs make better decisions about when a condition is serious and needs to be referred to secondary care in a shorter amount of time. But improving early diagnosis is a complex and time consuming issue, and discouraging patients from visiting their GP in the meantime will only make the problem worse.

However, RCN Secretary General Peter Carter is right when he says that “the political parties need to follow our lead and make it clear now, as we head towards a general election, what their policies are on future NHS funding.” With less than a year before the general election, the parties need to start coming up with concrete answers on how the NHS is going to be funded.

Frances Powrie

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