I watched a social media reel that horrified me. It stated that The BMA (British Medical Association) GPs Committee for England (GPC England) will ballot GPs in England on ‘Plan B’ which includes proposals to introduce means-tested, subscription-based GP care. My first instinct was to dismiss it as untrue or scaremongering. So, I investigated. It’s not.
Let me stop for a minute so you can consider that.
Means-tested, subscription-based GP care.
That means some of us, possibly most of us, will need to pay to see a GP.
What horrified me more, is that only one mainstream media outlet has covered the story. It’s the threat of privatisation by stealth, and most of us don’t even know it could happen.
In the UK, healthcare is available free at the point of access through the NHS. The important point here is that it is ‘free at the point of access’. That does not mean it is free. It’s not. We pay for it through our National Insurance contributions.
So, if means-tested GP care is introduced, then some of us will be paying for that care twice.
GPs will say this is not unprecedented. We already have a two-tier system when it comes to dentistry.
And look how that’s turned out.
Hands up who has an NHS dentist? The queues when a new one opens shows that being able to register with one, even if you need to, is almost impossible.
Furthermore, many NHS dentists complain they are paid a flat rate known as Units of Dental Activity (UDAs) regardless of complexity or time. This means they receive the same pay for a 15-minute filling as they do for complex root canal surgery. As a result, the British Dental Association claims that dentists are subsidising the NHS with their private practice income – to the tune of £332 million.
However, UDAs don’t just make a dent in a dentist’s earning potential, the system also impacts health outcomes for patients. For example, a dentist is paid the same for a root canal surgery as a tooth extraction; both treat pain and stop the spread of infection, but the root canal maintains the natural bite structure, preserves smile aesthetics and can offer a quicker recovery.[1] However, because extraction is significantly quicker, UDA may incentivise the wrong clinical outcome for the patient.
So why did GPs vote to explore means-tested, subscription-based GP care?
GPs are on the front line of healthcare and the service they offer has come under increasing pressure in recent years. They are not employed directly by the NHS and are instead contracted to deliver services.
In 2024, the five-year contract framework expired; it couldn’t be renewed at that time due to the general election, which meant there was no financial settlement for the NHS. Technically, the dispute ended in February 25 when the BMA, the trade union and professional body for UK doctors, accepted the Department of Health and Social Care’s (DHSC) changes on the condition that the Government committed to negotiating a new contract.[2]
However, rather than negotiating solely with the BMA, the Government consulted with a range of stakeholders, including the BMA. [3]
The new contract was published in February 26. Its value increased by £485 million to £13.863 billion, which the Government said was a 3.6% cash growth, or 1.4% real-terms growth.[4] The BMA disputes this stating that after inflation, the contract value has reduced by 0.26%.
The BMA responded with warnings that the requirement to provide unlimited same day care for patients with urgent clinical needs, even when a surgery was at capacity, would be unsafe and put patient care at risk due to the additional workload.[5]
The decision to put ‘Plan B’ to a ballot by the BMA comes after a resolution was passed at the UK Local Medical Committee (LMC) Conference earlier in May 26 that called for the consideration of a means-tested, subscription-based service.
I want to state very firmly here, I am not anti-GP and I understand why they have voted for this.
Alongside my work as a therapist, I have more than 25 years of experience in marketing, largely within the construction, property and manufacturing industries. Anyone in business knows that if you charge less than you bring in, then you go out of business very quickly. Similarly, if your key staff are overworked and overstretched, they leave, putting more pressure on the teams they leave behind.
The BMA says this is already happening, with some 6,500 full-time equivalent GP partners leaving the profession over the past 11 years.[6] Furthermore, some GP practices are simply no longer financially viable.[7] Since 2015, 1,465 independent community GP practices have closed or merged.[8]
GPs are simply trying to work out how their practices can survive, so they can continue doing what they trained to do. Giving front line care to patients.
What will happen if GP care becomes means-tested?
As a counsellor & psychotherapist, I work with people who have chronic illness and pain, terminal illness and lifechanging diagnosis, as well as with the family and friends who support them. One of the most common things I hear from clients is how it took multiple trips to the GP before their conditions were diagnosed and treated.
This isn’t unusual. According to Endometriosis UK, 47% of patients visited their GP 10 or more times before they went on to receive a diagnosis of endometriosis from a gynaecologist.[9] Sadly, such findings are not isolated to benign conditions. The Brian Tumour Charity found that 41% of respondents visited their GP three or more times before they received their diagnosis.[10]
The other thing I hear frequently (and have experienced myself as someone with a chronic illness) is that symptoms are either dismissed or are misdiagnosed. That means the treatment you are given (if you are given treatment) will not manage your symptoms so you have to return to your GP again.
Then, if you have a long-term illness, disability or multiple conditions, there’s also the issue of needing regular GP appointments to review your symptoms and medication. If you are immunocompromised, there’s also the risk of infection, which will again need regular GP support.
In all these cases, GP appointments are a necessary part of ongoing care, not a lifestyle choice.
The question is, if you must pay for care yourself, will you continue to go to your GP for the care you need? Or will you try and stretch the time between appointments? Or if you’ve not yet got a diagnosis, will you simply give up?
We don’t need to imagine what could happen if people give up or delay seeking diagnosis or treatment. It happened during COVID. As a result, an estimated 18,000 breast, 13,000 colorectal, 10,000 lung, and 21,000 prostate cancer diagnoses were missed between March 2020 and December 2021.[11] Cancer Research UK estimates that the missing cancer cases were disproportionately ‘early stage’ which means that when patients were diagnosed, their treatment outcomes may not have been so successful.
For those that do decide to pay to see their GP, I fear this will worsen inequality.
Those with a long-term health conditions are already trying to juggle symptoms and pain with family, relationships, work (if able) and other commitments.
Research also shows that those who do work (who are most likely to be subject to means-tested GP appointments) are already financially penalised. For example, the Office of National Statistics data shows that in the five years after someone is diagnosed with endometriosis, their average monthly income from work decreases by £56 per month. This suggests that they are working fewer hours or taking lower-paid jobs as they navigate the symptoms of the condition. And let’s be clear, endometriosis is a life-long full body disease – and it’s just one of many.
If you have a chronic, long-term health condition, a GP appointment will be a regular financial burden. You will in effect be paying an illness tax (on top of your existing national insurance contributions).
I fear that paid GP appointments will also further exacerbate mental health, which is often already fragile amongst those who have chronic illness and pain.
Can you imagine not only being dismissed by your doctor as malingering (essentially accused of making up your symptoms or being told they’re all ‘in your head’) and also having to pay for the privilege?
So, while it may be a solution for easing pressure on an overstretched system, it has the potential to do so at the detriment of the health of those who are already suffering most.
How likely is a means-tested subscription-based GP service?
The BMA has voted to explore the option of means-tested subscription-based GP service and will take a vote on Plan B by June 2027.[12] I hope it’s a negotiation tactic.
Legally, it would be a challenge. The NHS was founded on the principle that services are free at the point of use, and for all the discussions of privatisation by the back or the front door, this remains true of the service today. As a result, a General Medical Services (GMS)-contracted GP cannot currently charge NHS patients for NHS services.
But we shouldn’t dismiss it as impossible.
To start charging, GPs would have to start handing back their contracts back en masse. As mentioned earlier, some, albeit a small number, already have. If dissatisfaction continues, others could follow.
Dental treatment already operates on a two-tier system in the UK and that should act as a warning to us all. Don’t let our GP services go the same way.
What can I do to ensure GP care remains free at the point of access?
If, like me, the prospect of means-tested subscription-based GP services terrifies you, there are a couple of things you can do.
Write to your MP
Our MPs are elected to serve us, their constituents. They are required to log and respond to constituents’ correspondence. That means if enough people write about the same issue it gets raised in Parliament.
I recently listened to a talk with Tulip … who is campaigning about endometriosis. She said that every MP that attended a recent debate on the issue was there because they had a constituent who asked their MP to represent them.
We have the power – let’s use it.
If you’re in Kent, your local MP is Mike Martin and you can contact him here.
If you’re elsewhere in the country, you can find your local MP and how to contact them here.
Sign my Government petition
I passionately believe that GP services should remain free at the point of access through the NHS and should not become a two-tier service like dentists are. So, I have drafted a petition that calls for action from the UK Government.
- If an e-petition receives 10,000 signatures, it will receive a response from the Government.
- If it receives 100,000 signatures it may be debated in Parliament.
The petition is being checked by the UK Parliament and UK Government Petition’s Office. Once it is live I will post it here. Please check back in a couple of weeks to sign and share and help it get to 100,000 signatures.
[1] https://inspireddentalcare.co.uk/deciding-between-a-root-canal-and-an-extraction-a-comprehensive-guide/
[2] https://www.kingsfund.org.uk/insight-and-analysis/long-reads/gp-contract-explained#changes-to-the-pcn-des-
[3] https://practiceindex.co.uk/gp/blog/bma-set-to-lose-exclusive-role-in-contract-negotiations-in-pivotal-moment-for-practice-management/
[4] https://commonslibrary.parliament.uk/research-briefings/cbp-7194/
[5] https://www.bma.org.uk/bma-media-centre/gp-committee-for-england-rejects-government-s-unsafe-plans-for-unlimited-same-day-appointments
[6] https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice
[7] The future of funding for general practice, The Health Foundation
[8] https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice
[9] https://www.endometriosis-uk.org/diagnosis-report
[10] https://assets.thebraintumourcharity.org/live/uploads/2025/05/Faster-Diagnosis_Apr-2025_pages.pdf
[11] https://www.medrxiv.org/content/10.1101/2023.07.21.23292937v3.full.pdf
[12] https://www.mirror.co.uk/news/health/nhs-patients-warned-plan-b-37225893
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