B1497 – Missed GP Appointment Bill 2019 Watch

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Saracen's Fez
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What is this thread about?
This is a bill in the Model House of Commons (MHoC). It's a piece of proposed legislation that is currently being debated, and there's a good chance that the House will later vote on whether to pass it into TSR law. All are welcome and encouraged to ask questions about the bill's content and join in the debate – you don't have to be in a party or be an MP to do so.

What is the MHoC?
It's a political role-playing game where we pretend to be the House of Commons, and it's been going since 2005. We have formed parties, we have elections twice a year, and we debate bills and motions just like the real-life parliament. If you want to know more about how the MHoC works, your first port of call is the user manual. If you'd like to get involved and possibly join a party, you want the welcome thread.


B1497 – Missed GP Appointment Bill 2019, TSR Libertarian Party
Missed GP Appointment Bill 2019

An Act to deter people from missing GP appointments by charging a fee.

BE IT ENACTED by The Queen's most Excellent Majesty, by and with the advice and consent of the Commons in this present Parliament assembled, in accordance with the provisions of the Parliament Acts 1911 and 1949, and by the authority of the same, as follows:—

1.Missed GP Appointment Fee
(1) A fee of £10 will be payable if an appointment is missed.
(2) Payment shall be paid either online, or in person at the surgery, and pay the £10 by debit/credit card.
(3) It is up to individual surgeries to decide whether they will accept cash deposits in person and is up to them to make sure they have sufficient float to make this possible.

2.Cancelled Appointments
(1) An appointment will be classed as cancelled if it is cancelled
(a) online through the surgery's online booking tool,
(b) in person at least 2 working hours before the appointment,
(c) by phone at least 2 working hours before the appointment, and where the phone line is busy, a voice message left will suffice,
(d) by email at least 2 working hours before the appointment, if the surgery accepts email cancellations,
(e) by text at least 2 working hours before the appointment, if the surgery accepts text cancellations.

3.Exemptions
(1) Anyone who is under the age of 18.
(2) Pensioners of state pension age.

4.Fine
(1) The individual has 28 days to pay the fee according to clause 1.
(2) Failure to pay the fee within 28 days will incur a court order demanding payment.
(i) Fine will be 50% of the original fee on top of the fee.
(ii) Fine must be paid within 14 days.
(3) Failure to pay the fine within 14 days will result in no access to GP services until the outstanding fine has been paid.

5.Short title, Commencement, Extent
(1) This act may be cited as the Missed GP Appointment Act 2019
(2) This act comes into force on 1st April 2020
(3) This act extends to the United Kingdom


Notes
More than 15m GP appointments are wasted each year because patients do not turn up and fail to warn the surgeries they will not be attending. There are around 307 million sessions scheduled with GPs, nurses, therapists, and other practice staff every year and 5% – one in twenty – are missed without enough notice to invite other patients. Of these, around 7.2million are with busy family doctors, which adds up to more than 1.2 million GP hours wasted each year – the equivalent of over 600 GPs working full time for a year.

Each appointment costs an average of £30, putting the total cost to the NHS at more than £216million pounds on top of the disruption for staff and fellow patients that would pay for:

The annual salary of 2,325 full time GPs

224, 640 cataract operations

58,320 hip replacement operations

216,000 drug treatment courses for Alzheimer’s

The annual salary of 8, 424 full time community nurses

We believe this is unacceptable and waste of NHS resources which is already over stretched, as such, we charging patients £10 if they miss an appointment and to encourage them to attend or cancel in advance.
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ecolier
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Saracen's Fez Sorry I have no interest in join MHoC at the moment, but I have put forward arguments in response to a previous bill - has that not passed then?

https://www.thestudentroom.co.uk/sho...php?p=80547332
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Connor27
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(Original post by ecolier)
Saracen's Fez Sorry I have no interest in join MHoC at the moment, but I have put forward arguments in response to a previous bill - has that not passed then?

https://www.thestudentroom.co.uk/sho...php?p=80547332
I’m not Fez, but that’s only a motion, which is non-binding in the context of the game and wasn’t acted upon. The Libertarian item here is a Bill, which actually changes the law of our model U.K.
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Saracen's Fez
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(Original post by ecolier)
Saracen's Fez Sorry I have no interest in join MHoC at the moment, but I have put forward arguments in response to a previous bill - has that not passed then?

https://www.thestudentroom.co.uk/sho...php?p=80547332
Ah, that was a motion, so was just a statement of views, not a law. This is a bill, which aims to turn a proposal into actual law.
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ecolier
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(Original post by Connor27)
I’m not Fez, but that’s only a motion, which is non-binding in the context of the game and wasn’t acted upon. The Libertarian item here is a Bill, which actually changes the law of our model U.K.
(Original post by Saracen's Fez)
Ah, that was a motion, so was just a statement of views, not a law. This is a bill, which aims to turn a proposal into actual law.
Shows my ignorance in these things, but please do see my points raised in that thread because I think it will add to the debate.

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Connor27
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On the issue of this item itself; a firm aye.

Free universal healthcare struggles to fund itself as is, and if freeloaders make appointments without actually attending them this causes easily avoidable unnecessary strain.

A fine is a proportionate and necessary deterrent.
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Andrew97
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I’m leaning towards an Aye on this one at the moment.

My only qualm would be that it seems a bit draconian giving people a fine for missing an appointment once, when they might have genuinely forgotten as people do make errors. However that being said, sometimes we might need to be a bit draconian.
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ns_2
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Strong aye.

We cannot allow our NHS to be strung along, and have resources wasted; the right of free healthcare at the point of need must come with the responsibility of treating it with respect.
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CatusStarbright
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Aye on the whole. People are issued with plenty of reminders and have enough time to cancel appointments under this bill.

My only concern is the phrase 'without reasonable excuse' has been left out - what happened to that Mr T 999?
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Andrew97
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I have no idea who wrote this so hope for the best here.


Is, for example there are unforeseen circumstances that make me miss a GP appointment on the day after the 2hr deadline, what happens then?
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ThePootisPower
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Aye.
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Mr T 999
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(Original post by CatusStarbright)
Aye on the whole. People are issued with plenty of reminders and have enough time to cancel appointments under this bill.

My only concern is the phrase 'without reasonable excuse' has been left out - what happened to that Mr T 999?
I don't think it was in the bill was it? I could add that in the 2nd reading.

(Original post by Andrew97)
I have no idea who wrote this so hope for the best here.


Is, for example there are unforeseen circumstances that make me miss a GP appointment on the day after the 2hr deadline, what happens then?
You pay £10 fine.
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barnetlad
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If you assume that no GP appointments are urgent, a £10 fine and then a court order are expensive ways of tackling this. Taking away the option of online appointments for a period of time could be one option for the first failure, another could be that only certain time appointments become available for those who fail to cancel (those that are generally the most inconvenient).

Basic principle of penalising those who miss appointments and cannot be bothered to make contact I support.
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Mr T 999
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(Original post by barnetlad)
If you assume that no GP appointments are urgent, a £10 fine and then a court order are expensive ways of tackling this. Taking away the option of online appointments for a period of time could be one option for the first failure, another could be that only certain time appointments become available for those who fail to cancel (those that are generally the most inconvenient).

Basic principle of penalising those who miss appointments and cannot be bothered to make contact I support.
Court order only applies after 28 days. We believe this is reasonable amount of time they need to pay the £10 fine. Purpose of the fine is to deter, if people are worried about the court order they will make sure they pay the first fine.
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CatusStarbright
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(Original post by Mr T 999)
I don't think it was in the bill was it? I could add that in the 2nd reading.
I discussed it with you at great length and other members agreed with its inclusion as I recall.
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barnetlad
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(Original post by Mr T 999)
Court order only applies after 28 days. We believe this is reasonable amount of time they need to pay the £10 fine. Purpose of the fine is to deter, if people are worried about the court order they will make sure they pay the first fine.
Whilst 28 days is a reasonable time, the cost of notifying the fine must be around £5 for staff time and postage, and a court order I understand costs three figures. Digital sanctions or putting someone to restricted time appointments will cost much less, once systems are set up.
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Joleee
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i agree with everything ecolier said in the earlier debate. quoting here for reference.

(Original post by ecolier)
Please don't advocate a (blanket) fine system for people missing appointments.

I studied sociology and health economics as part of Medicine and it is usually the poorest, most dependent members of the society who cannot afford to come (time / childcare / transport arrangements etc. etc. - they are most prone to external factors).

By all means, fine the "forgetful rich" but that's quite rare. When I worked in an affluent area the DNA (Did Not Attend = missed appointment) rate is very low, now I work in a deprived area and the rates are sky high. Some London hospitals literally overbook their clinics, relying on their DNA rates - if everyone turned up, the clinic will be untenable.

I advocate text reminders or putting on appointment letters (or text) that each missed appointment will cost the NHS £160 (our trust states this) but not fining people, because ultimately it may discourage those most at risk and needs our help the most.
(Original post by ecolier)
Because of their reliance on external factors. The richer patients can afford childcare and taking time off work, for example. They may also drive. The poorer will have to rely on public transport, which can be cancelled; or their own method of transport which could be unreliable. They may also not be given time off work, or be asked to do something on short notice. Finally they may also not know how (or have the means) to cancel appointments or know that it is a waste not to cancel it.

Ironically, fining people will punish those who cannot actually afford it.
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tengentoppa
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Are there not devolution issues with extending the policy through the whole UK? I don’t recall whether the MHOC binds itself to real life in that way.

Regardless, the notes need to be looked at. The last paragraph in particular is an abomination.

Perhaps a clarification as to what would happen to the money would also be useful? Ringfenced NHS spending? Overall treasury revenue? First round at the pub (if so London-weighting of the fine would be necessary)?

An abstain leaning towards an aye as it stands, because the principle is laudable and the NHS is unsustainable.
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Mr T 999
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(Original post by barnetlad)
Whilst 28 days is a reasonable time, the cost of notifying the fine must be around £5 for staff time and postage, and a court order I understand costs three figures. Digital sanctions or putting someone to restricted time appointments will cost much less, once systems are set up.
It's still a small cost and not as expensive as you make it out to be. What do you mean by digital sanctions? If you look at the last punishment people lose access to GP services until outstanding fines are paid.
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Mr T 999
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(Original post by Joleee)
i agree with everything ecolier said in the earlier debate. quoting here for reference.
''(Original post by ecolier)
Please don't advocate a (blanket) fine system for people missing appointments.

I studied sociology and health economics as part of Medicine and it is usually the poorest, most dependent members of the society who cannot afford to come (time / childcare / transport arrangements etc. etc. - they are most prone to external factors).

By all means, fine the "forgetful rich" but that's quite rare. When I worked in an affluent area the DNA (Did Not Attend = missed appointment) rate is very low, now I work in a deprived area and the rates are sky high. Some London hospitals literally overbook their clinics, relying on their DNA rates - if everyone turned up, the clinic will be untenable.

I advocate text reminders or putting on appointment letters (or text) that each missed appointment will cost the NHS £160 (our trust states this) but not fining people, because ultimately it may discourage those most at risk and needs our help the most.''

Text reminders are already used by many GP practices and they are not working it still costing the NHS. A £10 fine is affordable and in line with prescription charges so it's not too expensive. We have been quite lenient and given them 28 days to pay this, which is a reasonable amount of time to come up with the money and pay the fine so it will not affect the poorest as much as you claim.

''(Original post by ecolier)
Because of their reliance on external factors. The richer patients can afford childcare and taking time off work, for example. They may also drive. The poorer will have to rely on public transport, which can be cancelled; or their own method of transport which could be unreliable. They may also not be given time off work, or be asked to do something on short notice. Finally they may also not know how (or have the means) to cancel appointments or know that it is a waste not to cancel it.

Ironically, fining people will punish those who cannot actually afford it.''

People are given enough notice to cancel the appointment and not occur a fine. You have 2 hours before the appointment to cancel so should your boss deny you time off or something comes up short notice you can cancel the appointment. There are various means to cancel an appointment as outlined in clause 2, online booking tool, in person, text, phone, and email so that shouldn't be an issue.

A fine is needed to deter people from missing appointments and should they miss one the costs need to be recovered. We can't waste millions on the NHS for people to miss appointments.
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