Every few years, whenever the NHS enters another period of intense pressure, the same suggestion reappears: “Should patients pay to see a GP?” Read on as our primary care correspondent gives their own personal view on the subject. Do you agree?

Sometimes it is framed as a subscription, sometimes a nominal fee, sometimes a penalty for missed appointments. The packaging changes, but the principle does not — and it remains deeply concerning. I am firmly opposed to charging patients in any form.

Having worked in general practice for many years, I have heard these discussions repeatedly. They tend to surface when the system is under strain, often proposed by individuals who do not fully understand the operational, ethical, or social consequences.

Charging patients creates a two‑tier system, and it is always the poorest, the elderly, and the most vulnerable who are affected first and most severely.

1. Charging Patients Undermines the Core NHS Principle

The NHS was founded on a simple and powerful promise: Healthcare is provided according to need, not ability to pay.

Introducing charges — even a token amount — breaks that principle immediately.

We have already seen the consequences in NHS dentistry:

• patients delay care because they cannot afford it
• conditions worsen
• inequalities widen
• emergency departments become the default safety net

Replicating this in general practice would be a profound step backwards.

2. Subscription Models Create a Two‑Tier System

Some commentators have suggested a “dentistry‑style subscription” for GP access.

In practice, this means those who can pay receive faster access, and those who cannot are left behind.

This is the very definition of a two‑tier system.

Private GP services already exist, and patients are free to choose them. But NHS general practice must remain free at the point of use, or it ceases to be the NHS in any meaningful sense.

3. The Elderly and Low‑Income Patients Would Be Disproportionately Affected

These groups:

• rely on general practice the most
• have the least disposable income
• already struggle with essential costs such as heating, food, transport, and medication

Introducing charges would push them away from care. Delayed consultations would lead to more advanced illness, more hospital admissions, and greater pressure on the wider NHS.

We would be penalising the very people the NHS was created to protect.

4. The Operational Realities Are Unworkable

Those who propose charging mechanisms often have little understanding of how practices function. Consider the practicalities:

Who would collect payments? Reception teams already face unacceptable levels of abuse. Expecting them to act as cashiers or debt collectors is neither safe nor reasonable.

What happens if a patient owes money? Do we refuse to see them? Turn away a sick child? Ask an elderly patient with chest pain to settle their bill first?

How would emergencies be handled? Invoice afterwards? Chase debt? Issue reminders?

What about safeguarding? Would we deny care to someone fleeing domestic abuse because they missed a payment?

And the administrative burden? Practices already struggle to receive payment for work they legitimately undertake. Introducing a billing system would be costly, complex, and entirely incompatible with the ethos of general practice.

5. Fines for DNAs Are Equally Problematic

The idea of fining patients for missed appointments resurfaces frequently. Yet the practical and ethical issues are immediate:

• What if the patient has dementia?
• Learning difficulties?
• No credit, transport, or phone?
• Is in crisis?
• Booked the appointment weeks ago and simply forgot?

And again:

• Who collects the fine?
• What happens if it is not paid?
• Do we refuse future care?

This approach risks punishing the most vulnerable and would create more problems than it solves.

6. Why These Rumours Persist

The NHS is under extraordinary pressure:

• hospital backlogs
• workforce shortages
• industrial action
• reduced community services
• rising demand

When access becomes difficult, misinformation spreads. General practice — as ever — becomes the default safety net for the entire system.

Charging patients will not resolve these pressures. It will simply push people away from care until their conditions become more serious and more costly.

7. Recent Discussions About Mixed NHS/Private GP Models

A further concern is the recent public discussion — in the media, policy circles, and among a small number of clinicians — about GP practices operating both NHS and private patient lists simultaneously.

This is often presented as a way to generate additional income, a means of offering faster access privately, and a “hybrid model” similar to dentistry.

However, this is a two‑tier system in all but name.

Under current NHS regulations, practices cannot:

• prioritise private patients
• offer faster access privately for NHS‑covered services
• use NHS‑funded staff or time for private GP appointments

The fact that such models are even being discussed reflects the fragility of general practice. It also demonstrates how easily the door could open to a system where those who can pay are seen sooner.

This is precisely why charging patients must be rejected outright. Once the principle is breached, the slide into a two‑tier GP service becomes inevitable.

Selected References & Sources

• NHS Constitution for England (2024) — NHS services must remain free at the point of use.
• NHS England (2026). General Practice Contract Arrangements 2026/27 — Confirms no charging mechanisms.
• NHS England (2025). Primary Care Access Recovery Plan — Focuses on improving access without fees.
• GMC (2026). Workforce Report to the Health and Social Care Committee — Highlights pressures but does not recommend charging.
• House of Commons Health and Social Care Committee (2025–2026). Evidence on General Practice Workforce Pressures.
• BMA (2025). General Practice: Funding, Access and Equity — Strongly opposes charging patients.
• Recent media reporting (2026) on discussions around subscription‑style and mixed NHS/private GP models.

The views expressed in this article are the views of the correspondent author and do not reflect the views of FPM Group or Stericycle.