“I fiercely oppose Sajid Javid’s proposal to introduce fees for GP appointments and A&E visits”: DAUK co-chair Dr Ellen Welch writes in the Metro

DAUK co-chair Dr Ellen Welch writes about her experience in working in private healthcare and says, “I fiercely oppose Sajid Javid’s proposal to introduce fees for GP appointments and A&E visits.” 

“His idea isn’t new. Debates over NHS payments have raged since the creation of the service, and the evidence we have for charging patients shows that, even with exemptions in place, a fee to see the doctor widens health inequalities by deterring the poor and vulnerable from seeking help.”

Dr Welch talks about her experience of providing healthcare service in a cruise ship, where medical care comes with a hefty bill, and says, “A cruise ship is a microcosm of society and I believe all these examples will play out on a wider scale if fees are introduced to the NHS.”

“A recurring argument in favour of charging in the UK is the one that presumes a fee will reduce the ‘unnecessary’ presentations. The patients that ‘don’t need to be there’ – that people ‘will think twice’. Well, I would disagree.

I remember many patients happily paying at least $100 to see me on board the ship, when their money would’ve been better spent elsewhere.”

But the fact a fee is in place does raise ethical questions. If a doctor asks for a follow up visit, are they being caring or will they be branded money-making?

We all heard rumours on board about the early days of cruise ship medicine, where staff worked on commission. Stories of patients attending with a cold, and being offered x-rays, swabs and bloods, and a host of expensive treatments, all for a substantial bill.

Paying customers may want the reassurance of a barrage of tests – but unnecessary tests can have harm attached. Assigning a fee to healthcare changes the dynamic completely.

Javid advocates introducing these fees, to ‘help with the allocation of what will always be limited resources’.

‘What frustrates people,’ said Javid, ‘is having to wait for GP appointments.’


When I had a busy clinic on board, and a waiting room full of sick, paying passengers, they still all had to wait to see me. In my experience, a consultation fee doesn’t help with waiting times. Just look at the waits for NHS Dentistry if you’re not convinced.

What the UK is desperately in need of is more staff. We need to retain those we have left.

I’m a GP these days, and co-chair of Doctors’ Association UK. We urge the Government to speak to groups like ours – made up of frontline staff who have lived experience of the system – to seek solutions that do not disadvantage people by making them pay.

If they don’t, and proceed with introducing fees, I can’t help but think: ‘at what cost?’”

Read the full article here.