Out-of-hours G.P. service

20.09.22

9 Deputy C.S. Alves of the Minister for Health and Social Services regarding the out-

of-hours G.P. service (OQ.249/2020):

Will the Minister explain why prior to COVID-19 the out-of-hours G.P. (general practitioner) provided telephone advice free of charge but the advice now incurs a charge of £20?

The Deputy of St. Ouen (The Minister for Health and Social Services):

G.P. practices, including the out-of-hours services, are able to charge for a video or telephone consultation if they wish, and these charges are not laid down by Government. So it may be that there was a time when a particular practice made no charge and may now charge £20.

1. Deputy C.S. Alves :

I was referring to the out-of-hours G.P. service so can the Minister therefore confirm, are those charges set by each individual G.P. practice or are they set centrally, as this is a service that I believe is provided from the hospital?

The Deputy of St. Ouen :

I believe the G.P.s who combine together to provide that service decide upon their charges. It is true it is run from the hospital and there is an agreement whereby Customer and Local Services would provide a rebate for any fees charged, in the same way that that happens in a face-to-face consultation in normal surgery hours. But the charge payable by the patient is set by the G.P.s participating in the scheme because they are independent practitioners and businesses, and are in business as commercial enterprises.

2. Deputy R.J. Ward :

Can I extend this to a small matter but one that has been brought to my concern for the Minister? It is the same for repeat prescription charges that previously in some places were a nominal charge of £2 and have been raised to £5 because the prescriptions are being dropped at the pharmacy, which is sometimes just downstairs. Is it the case that it is because of the independent business nature of the G.P.s in this way that these charges are increased, and does the Minister have any say or influence over these charges? They may be small but they are significant for some.

The Deputy of St. Ouen :

I think the Deputy is right, I cannot tell the G.P.s what to charge in their businesses.

3. Deputy G.P. Southern :

Is it the Minister's intention to maintain this position whereby G.P.s can set their own fees for the delivery of whatever service they should choose; and does he not, along with the Minister for Social Security, intend to take greater control over how and how much G.P.s can charge?

The Deputy of St. Ouen :

I think it is pretty clear that the Island does not want government to control G.P.s. There has been some fear of that and Members will have received letters about even suggesting that we are on a course to nationalise the health service or bring all G.P.s under the wing of government, and that is not the case and I do not wish it to be the case. I think we are well served by our G.P.s as independent practitioners, but the Deputy knows that we are working on a scheme to help those who are financially vulnerable so that we do not see the harmful ill-effects of people being unable to

afford healthcare and their health suffering as a result. So we will mitigate and intervene in the market in that way, but there is no sense in which we are taking away from the independence of G.P.s as professionals in business.

4. Deputy M. Tadier :

The Minister said that the Island does not want us to control G.P.s and does not want us to nationalise the G.P. service, but would the Minister reconsider his words and acknowledge that the Island is not homogenous and in fact there are many different views. From a user point of view, what many people who cannot afford doctors and who do not have the habit of going to see a doctor on a regular basis, they notice that the access that was provided around COVID-19 was very helpful and that might be the first context in which they have come into contact with a medical professional free of charge during what has been a health crisis. Does he acknowledge that point?

The Deputy of St. Ouen :

Yes, of course, I acknowledge there are different views and each view has some merits and some demerits. My comments are drawn, I think, from a survey of some years ago, a government survey, in which people it seems wished to retain the present arrangements. But equally I know G.P.s are anxious to ensure that we have the best healthcare that we can deliver on the Island, and the situation is evolutionary. This is what the Jersey Care Model will envisage; change takes place, learning from best practice that all practitioners seek to achieve, and we will work together to improve access to healthcare. But I believe it is more an evolutionary process rather than a revolutionary process.

5. Deputy M. Tadier :

Does the Minister acknowledge that philosophically and politically speaking there is absolutely nothing wrong with regulating the price that G.P.s can charge? We do it for taxi drivers; for example, we tell taxi drivers how much they can charge for a particular journey, yet is not healthcare much more important than transportation in the Island?

The Deputy of St. Ouen :

That is a huge issue that would need to be addressed in a substantial debate if we wish to have it. I think the important thing is to make sure that those who are vulnerable can access healthcare rather than imposing across the board measures in a system that needs some tweaking but essentially provides excellent healthcare for the Island.

6. Deputy C.S. Alves :

Can the Minister therefore tell me what work or data was analysed on the potential impact of introducing this charge which did not exist prior to COVID?

The Deputy of St. Ouen :

It is not a charge the Government introduced; it is a commercial decision taken by the G.P.s so there was no government research around it I believe. I could just say if patients are concerned about having been charged or the quality of service they receive then they can discuss that initially with the practice but unresolved issues can also be referred to the primary care governance team, which does sit within Government.