Many Primary Care Trusts have failed to enforce GP contract revisions that should have eliminated use of 084 telephone numbers by 1 April 2011 - see my database of those in breach. If this is anything more than falling for the misrepresentations made by those who believe that patients should pay to fund GP telephone systems, then it is a positive sanction for co-payment.
Many of us fear that co-payment will have to become a general feature of the NHS, as the proposed "reforms" are unlikely to achieve the cost savings on which they depend. More choice and improved outcomes may be desirable goals, but they cannot be expected to deliver cost savings. Replacing one centralised bureaucracy with lots of separate versions of the same thing is not guaranteed to save money either.
Sanctioned co-payment (which is presently prohibited) is undoubtedly coming on a grand scale. Do we see a model in the way that revenue sharing telephone numbers are used by 12.25% of English NHS GP surgeries? The Department of Health declares no interest in this matter - see this written answer.
I have written to the Chief Executives of the PCT's who are clearly having the greatest difficulty in protecting the patients they serve from being forced into co-payment. See my letter - see my "Top 20" lists.
I have asked them to confirm whether or not their failure to ensure compliance with contract revisions within the specific time limits indicates incompetence, or a policy of sanctioning co-payment by the NHS patients that they serve.
Amidst all of the politicking around the "NHS Reforms", the fact that co-payment is already here and likely to increase significantly has perhaps been missed. The relatively modest issue of use of revenue sharing telephone numbers has however perhaps been pointing the way forward.
The BMA GPC has expressed the principle of co-payment very clearly by its policy on use of expensive telephone numbers. The following quote is from its guidance to members on how to get around the contract revisions - by offering a meaningless, and essentially false, assurance about telephone call charges from an interested party with no competence in the matter being addressed.
"Calls to NHS services should incur as low a charge as possible, but that this must be balanced by the quality of communications service that the patients are accessing."
Balancing cost to patients with the quality of service delivered by the NHS is exactly what co-payment is all about. A patient's right to choose cannot be divorced from their "right" to pay for a quality of service that the NHS "cannot afford". That however is the end of a universal comprehensive National Health Service "free at the point of need".