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Doctors breaking 'free NHS' principle
By: John Carvel
The Guardian, March 30, 2001
Thousands of old people in care homes charged for visit from GP.
Thousands of older people in care homes and sheltered housing are being forced to pay to see an NHS doctor in flagrant breach of the principle that state medical services should be free, charities claimed last night.
An investigation of 183 charitable homes found 34% were paying retainers of up to £10,000 a year to get attention. Fees averaging £41 a year for each resident were commonly introduced at the request of GPs who were already collecting £45.05 from the NHS for each patient on their lists over the age of 75.
In some cases the fee topped £150 a year and there were extra charges for basic services such as winter flu jabs, said a report by the Association of Charity Officers.
Although the homes were meeting part of the cost from their charitable income, many were obliged to pass on charges to residents. The result was a breach of the principle that services should be provided according to need and free at the point of use.
This week the government published a strategy to improve NHS services for older people and eliminate discrimination. At a press conference on Tuesday, John Hutton, the health minister responsible for social care, said he was not aware of older people being charged for primary care. "If there is clear evidence ... bring it to my attention."
Valerie Barrow, director of the Association of Charity Officers, said yesterday: "This study clearly shows that some older people, because of where they live, are paying twice."
Tessa Harding, head of policy at Help the Aged, said: "It is outrageous that older people in residential and nursing homes are having to pay over the odds for something the rest of us get free. I cannot believe it is the government's intention that those who need healthcare most should have to pay."
The report found "damaging evidence of confusion over the definition of core NHS services". While 80% of GPs provided free winter flu jabs for residents of care homes and sheltered housing, 20% listed the inoculation as a "contracted" service.
About 10% of GPs conducted special surgeries in care homes at no extra cost, but 27% charged a retainer without offering on-site surgeries. "The blurred definition of core NHS services means many older people in residential care homes are denied healthcare free at the point of need," the report said.
The British Medical Association (BMA) said it had been asking the government for at least seven years to increase NHS cover for people in nursing homes.
Andrew Dearden, chairman of the BMA's community care committee, said: "General practitioners are left with few options. They could decide on no extra services at all. They could decide to supplement the NHS without any financial support or additional resources, but that would impact on the care of their other patients. A third option for GPs would be to say to the homes that they want to provide extra services as non-NHS services - and would the homes be willing to pay for them?"
The Department of Health said GPs were entitled to charge for services such as training staff. "That is different from direct patient services. We will investigate any allegations of abuse," a spokesman said.
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