Patients across England could soon be asked to pay means-tested monthly subscription fees to see their GP, akin to a 'Netflix-style' model, under controversial new proposals being considered by family doctors. The British Medical Association's GP committee has confirmed it will ballot doctors on what it describes as a 'plan B' or 'alternative strategy' for general practice, which could allow practices to offer additional services to patients willing to pay.
Shift from NHS Principles
This move would mark a significant departure from the founding principle of the NHS, where care is free at the point of use, and risks creating a two-tier system. Under the suggested model, patients could pay a regular fee to access services outside the standard NHS offer, similar to NHS dentistry, where some treatments cost up to £319. GP partners, who are self-employed, currently earn an average of £159,000 before tax, with increasing numbers also taking on private work.
Background and Context
The proposals follow a vote by GP leaders earlier this month to draw up plans for 'exiting' NHS contracts and exploring options for working outside the health service. Some leaders suggested that quitting the NHS could be used as leverage in the ongoing dispute between doctors and the government. Dr Katie Bramall, chair of the BMA's GP committee, said doctors were 'deeply frustrated' and had 'no other choice but to explore alternatives'. She warned that confidence in the future of general practice within the NHS was now 'at an all-time low'.
'This didn't happen overnight,' she told Pulse. 'It has been a slow and gradual deterioration of morale within the profession. We risk losing NHS general practice entirely if urgent action is not taken.' Dr Bramall highlighted years of under-investment, rising workloads, and staff shortages that have left many GPs struggling to provide safe care. She added that current contract arrangements limit doctors' ability to meet patient demand, restricting the services they can offer.
Criticism and Opposition
Critics argue that the move towards subscription or private-style models could entrench inequality, allowing those who can afford to pay to access quicker or better care. The Department of Health and Social Care has voiced strong opposition to any shift towards paid-for GP services. A spokesman told The Telegraph: 'Moving towards a model of private, means-tested or subscription-based GP services is not in the interests of patients or the NHS. A two-tier health system would only serve to deepen the health inequalities that already exist. The founding principle of the health service - that care is free at the point of use - must be protected, and we will do so.'
Previous Actions and Future Steps
GP leaders have previously discussed drastic measures, including mass resignation from NHS contracts, to force improvements to funding and working conditions. Last year, local medical committees authorised the BMA to use the threat of GPs 'walking away' from the NHS to strengthen its negotiating position. Separate protest actions have included proposals to cap the number of patients doctors see each day. At the same time, a growing number of GPs are supplementing their income by working in private healthcare or for online medical services.
The ballot on the 'alternative strategy' will determine whether GPs in England will formally support the introduction of subscription-based services, potentially reshaping the landscape of primary care in the country.
