Patients could have to start to pay charges to use basic NHS services such as GPs because the health service’s finances have become so dire, the leader of Britain’s doctors has warned.



Dr Mark Porter, the head of the British Medical Association (BMA), said that whoever took office after the general election would inevitably be tempted to bring in charges and may not be deterred by the unpopularity of such a seismic change to the health service.

In an interview with the Guardian, Porter said: “I think they will be tempted. They said in 1950 that a Labour government wouldn’t introduce charging and it did.”

The introduction of prescription charges prompted the NHS founder, Nye Bevan, to resign from Clement Attlee’s government in April 1951.

The existence of such charges for some areas of healthcare could persuade ministers to extend fees to others, Porter said. The health service in England raises about 1% of its income from charging for services such as prescriptions and dental care.

Porter said it would be “inescapable” that the next government would consider introducing fees as a way of tackling the £30bn budget gap that NHS England has forecast will open by 2020 unless it achieves its target of £22bn in efficiency savings and receives £8bn of extra annual funding from the Treasury at a time when overall public finances remain under pressure.



“You say it’s politically toxic. It’s not, really, is it? Look at dentistry and look at social care. They carry with them exactly the same offer to the public by which the NHS was set up; that we will remove from you – this society, us acting collectively – the terrible fear of bankrupting yourself by having an illness, by needing healthcare.

“And yet we allow people to be bankrupted by social care and we allow people to be deterred from seeking dental care because of charges,” Porter said.

“Your question was: could a future government be tempted? Yes, they could, but they must resist that temptation.”

The BMA represents 153,000 of the UK’s 250,000 doctors.

The BMA chief, Dr Mark Porter. Photograph: Frank Baron/the Guardian

No leading politician from any of the three main parties has backed charges, but Prof Sir Malcolm Grant, the chair of NHS England, said in 2013 that “it’s something which a future government will wish to reflect [on], unless the economy has picked up sufficiently, because we can anticipate demand for NHS services rising by about 4% to 5% per annum”.

Fees would damage “the defining value of the NHS because it’s not just a health system. It’s a social support system,” he said.

Four in 10 people in England pay for prescriptions, at a price of £8.20 an item. Much dental care is now private, although a small number of NHS surgeries remain.

Porter, an NHS anaesthetist in Coventry, said charging for GP visits or other services would “destroy the ultimate ethos of the NHS” by ending its status as a universal service free to all at the point of use.

While superficially attractive as a way of raising money, charges would be morally wrong, he said. “It’s inescapable that you’re deterring people from seeking healthcare. You deter poor people and sick people from seeking the healthcare they need.”

There is no evidence that charging patients £10 to see a GP would reduce demand for appointments or reduce the number of “worried well” seeking care. Fees also run the risk that people who do not seek medical help because they cannot afford them may turn out to have a major illness, Porter said.

The complexity of collecting payments and deciding who should pay and who should be exempt would also nullify the revenue gained, Porter added.

Porter’s intervention forced the three main parties, which are already engaged in a war of words over which would give the NHS the most money over the course of the next parliament, to insist that they would not introduce charges regardless of post-election financial pressures.



A survey published on Saturday revealed that 85% of respondents agreed the government should support a tax-funded NHS that is free at the point of use and provides comprehensive care to all citizens.

The Ipsos Mori poll of 1,800 people, conducted for thinktank the Health Foundation, found that 59% would back tax rises to provide extra funding for healthcare. Only 16% said they would support any new fees, such as charging £10 for a GP appointment.

Labour said it would never seek payment for any NHS service. The Conservatives also “categorically” ruled out imposing fees for any type of NHS care. The Liberal Democrats said they were “absolutely committed” to it remaining a free-to-use service.



“Labour will never introduce charges for any NHS service. It must remain free at the point of use, and only our fully funded plan to put in an extra £2.5bn each year – over and above the Tories – gives the NHS the money it needs”, said Andy Burnham, the shadow health secretary.

He and Ed Balls, the shadow chancellor, said last month that the Tories’ plans for further cuts to public spending after the election meant they could use NHS charges to help balance the books.

“David Cameron has prioritised unfunded tax cuts over the NHS and his extreme plans to cut spending by more in the next three years than the last five mean that he cannot protect the NHS and its free status,” Burnham said.

A Conservative spokesman rejected that claim. “We are committed to securing a strong future for the NHS, free at the point of use, so when people are ill they do not need to worry about being able to afford treatment. Unlike Labour, we will never forget that a strong NHS needs a strong economy.”

Norman Lamb, the Lib Dem health minister, said: “We are absolutely committed to the NHS remaining free at the point of delivery. That’s why we are the only party to have committed to giving the NHS the £8bn extra investment NHS bosses say is needed by 2020. Neither Cameron nor Miliband have matched our pledge, leaving the NHS at risk under either of the other two main parties.”

Lord Warner, a health minister under Tony Blair, last year proposed that everyone should start paying a £10-a-month NHS “membership charge” to help rescue its ailing finances in a paper for Reform, the centre-right thinktank.

Last month, the Social Market Foundation, a centrist thinktank, suggested the introduction of personal care accounts, which individuals and the state would pay into to cover the cost of NHS treatment and social care.

• This article was amended on 6 April 2015 to clarify that in the UK prescription charges apply only in England. Prescriptions are free in Wales, Northern Ireland and Scotland.