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So, doctor, was I worth £10?
  1. Lauren Waterman
  1. Correspondence to Dr Lauren Waterman, Royal Sussex County Hospital, Eastern Road, Brighton BN25BE, USA; laurenzwaterman{at}, lauren.waterman07{at}

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Dear Editor I write this letter in response to the recent survey which showed a third of general practitioners to support patient fees for ‘unnecessary’ Accident & Emergency (A&E) visits.1 The idea is that patients would be charged £5–£10 and this is refunded if doctors deemed the visit appropriate. I propose three key reasons why this charge would be impractical, unethical and dangerous.

First, A&E doctors would have to get into discussions with patients as to why their payment cannot be refunded. These discussions will be awkward for the doctors, impact upon the doctor–patient relationship and also take up the doctors’ time, where resources are what we are trying to save in the first place.

Second, it stops the NHS being ‘free at the point of care’ which is a fundamental feature of its constitution. This may defer certain lower-economic patient groups (those groups that may have less education about heath and illness in the first place) from presenting to A&E when something may actually be wrong.

Third, when patients present to A&E, they do not wait in a busy waiting room for fun! They believe that something needs urgent medical attention. This intervention would not educate patients as it is unlikely that doctors would have time to fully explain why a patient's visit was justified or not. There would be discrepancy between different doctors in what they believe to be a ‘legitimate visit’ with some willing to refund for certain presentations that others believe to be ‘not warranting a visit’. This would confuse patients further and not help them to make ‘better decisions’ the next time.

To conclude, although vast costs are incurred by patients who attend A&E without requiring urgent treatment,2 charging patients is not the answer. Patients who are without extensive medical knowledge are not trained to know when symptoms signify something sinister. However, perhaps further educational intervention that teaches the public more about the different options available to them would help direct them to the right place.


  • Contributors This article was written by LW. There were no other authors or contributors to this article.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.