Motions submitted to the BMA Local Medical Committees UK Conference 2014

27 To be proposed by WILTSHIRE That conference:

  • (i) believes that general practice is unsustainable in its current format
  • (ii) believes that it is no longer viable for general practice to provide all patients with all NHS services free at the point of delivery
  • (iii) urges the UK governments to define the services that can and cannot be accessed in the NHS
  • (iv) calls on GPC to consider alternative funding mechanisms for general practice
  • (v) calls on GPC to explore national charging for general practice services with the UK governments.

27a WILTSHIRE That conference believes the time is right for a fee for service for general practice.

27b AVON That conference calls on GPC to explore with the Department of Health the alternatives to a completely free at the point of access system.

27c GLOUCESTERSHIRE That conference believes the time has come to impose a national charge for consultations as part of a strategy of demand management.

27d KINGSTON AND RICHMOND That conference believes that alternative funding mechanisms for general practice must be explored in order to preserve universal general practice.

27e GLOUCESTERSHIRE That conference requires the GPC to consider a fundamental change to the contract, such as an alternative system of funding, as for instance that used in Guernsey.

27f MID MERSEY That conference believes as with dentistry and ophthalmology services, it is no longer viable for general practice to provide all NHS services free at the point of delivery for all patients.

27g NORTHERN IRELAND CONFERENCE OF LMCs That conference believes that in the light of the ongoing financial constraint facing the health service, along with the increasing demand for services, that the subject of what the NHS can afford and be reasonably expenses should be revisited, along with the subject of co-payments.

27h DEVON That conference believes the only meaningful way to engage patients in the issue of spiralling drug costs, is to explore some form of co-payment for medications provided by the NHS.

27i CORNWALL AND ISLES OF SCILLY That conference believes patients should be charged for repeated appointment DNAs and the inappropriate use of GP and A&E services.

27j DERBYSHIRE That conference:

  • (i) believes that the principle of an NHS that is universal, comprehensive, free at the point of access and funded from general taxation is no longer sustainable in the current political and economic environment
  • (ii) urges the UK governments to design and implement systems of co-payments for all NHS services as a matter of urgency
  • (iii) urges the UK governments to limit the demands upon the NHS by defining, nation by nation, those types of service that can and cannot be accessed on the NHS.

27k LANCASHIRE COASTAL That conference believes that, due to increasing demands and reductions in funding, general practice in its current format is unsustainable.

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  1. Johannah Buchan says:

    This is absolutely appalling. How many of them were educated, at least in part, at taxpayers expense. All we need do is raise expenditure to same % of GDP as most of G7.

  2. Martin Rathfelder says:

    From the The World health Report: Health systems financing: the path to universal coverage.

    Three fundamental, interrelated problems restrict countries from moving closer to universal coverage.

    The first is the availability of resources. No country, no matter how rich, has been able to ensure that everyone has immediate access to every technology and intervention that may improve their health or prolong their lives. At the other end of the scale, in the poorest countries, few services are available to all.

    The second barrier to universal coverage is an overreliance on direct payments at the time people need care. These include over-the-counter payments for medicines and fees for consultations and procedures. Even if people have some form of health insurance, they may need to contribute in the form of co-payments, co-insurance or deductibles. The obligation to pay directly for services at the moment of need – whether that payment is made on a formal or informal (under the table) basis – prevents millions of people receiving health care when they need it. For those who do seek treatment, it can result in severe financial hardship, even impoverishment.

    The third impediment to a more rapid movement towards universal coverage is the inefficient and inequitable use of resources. At a conservative estimate, 20–40% of health resources are being wasted. Reducing this waste would greatly improve the ability of health systems to provide quality services and improve health. Improved efficiency often makes it easier for the ministry of health to make a case for obtaining additional funding from the ministry of finance. The path to universal coverage, then, is relatively simple – at least on paper. Countries must raise sufficient funds, reduce the reliance on direct payments to finance services, and improve efficiency and equity.

  3. Brian Gibbons says:

    There has always been a small constituency amongst GPs for ending universal coverage.

    At different times different flags of convenience have been hoisted to justify the call e.g. to prevent patients consulting with “trivial” complaints, to prevent patients using out-of-hours service, patients only appreciate a service if they have to pay for it etc etc etc.

    On this occasion the rational is to improve funding. And how much will be spent on collecting the co-payments? Who will do it? And if the patient says they cannot afford it or forgot their wallet / credit card, what happens?

    Many GPs are fairly disenchanted with the present direction of the NHS but it is hard to believe that they will support this sort of thing.

  4. Brian Cox says:

    Charging for first contact care and advice from general practice is an incredible proposition. General practice is often the only place where excluded and disadvantaged people get access to diagnostic and support advice that they need. We should be extending this facility and thinking about ways to reach more people not introducing barriers to access.

  5. Brian Fisher says:

    Naturally, we cannot support charging for GP care. It will be inequitable, inefficient and ineffective. Although we need to demand more funding for community care, we should not be expecting this at the expense of hospital care. We cannot any longer support a battle between community and hospital care. There is vanishingly little evidence that effective community care reduces hospital use cost-effectively. Although I can find little evidence for this, I suspect that we are reaching the limits of safely reducing hospital bed numbers.

    We now need to argue for:
    – increased funding for the NHS as a whole
    – a focus on maximising the capacity we already have, making the system as efficient as possible, using technology where possible, harnessing community involvement, shortening length of hospital stay, making community care as efficient as possible.
    – focusing on public health measures: a living wage, equitable working practices, minimum pricing for alcohol.

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