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It was agreed that no payment should be made either from the Fund or by a patient where the only service was to repeat a prescription. 23. Mileage.—The Committee recommends that consideration should be given to the question of some increase in the present ordinary mileage payment from the Fund of Is. 3d. per mile , (fixed by section 5 of the Social Security Amendment Act, 1941), with the general intention that the amount paid from the Fund will be accepted in full satisfaction of the doctor's charge by way of mileage. The Committee felt that this question should be the subject of further discussions between the Association and the Department. The Committee recognized that the complete abolition of mileage charges to patients calls for some other deterrent against unnecessary and time-consuming visits to distant places. 24. Increase in Payment for Domiciliary Attendance. —The scale of payments from the Fund recommended in paragraph 22 is substantially as at present, except that the Committee suggests an increase of 2s. 6d. for an attendance at the patient's home. Sincethe General Medical Services Scheme was inaugurated in 1941 a uniform fee of 7s. 6d. has been paid from the Fund for an ordinary attendance in the doctor's surgery or a visit to a patient's home or elsewhere. The Committee appreciated that the fee had been made a uniform one on the assumption that the ratio of attendances in the surgery tovisits would be much the same for all general practitioners in urban areas and that, so far as practitioners in rural areas were concerned, the mileage payments would adjust matters. It has, however, continued to be the regular custom for many practitioners to charge a higher fee for a visit than for an attendance in the surgery. The ratio of attendances to visits undoubtedly varies a good deal among practitioners. The present uniform payment encourages those individuals who are inclined to deal with unduly large numbers of patients in their surgeries. They, of course, are able to claim the same fee for every attendance no matter how little time is involved. The Committee feels, therefore, that a distinction should be made as regards the fee for an attendance in the surgery and an attendance in the patient's home. That this should be done by increasing the payment in respect of a domiciliary visit is conditional upon measures being taken, as recommended elsewhere in this report, to control the amounts paid to practitioners generally. 25. The Committee contemplates that the amounts payable from the Fund will in many cases be accepted in full satisfaction for the services rendered. Indeed, the Committee expects that there will be a proportion of cases, varying with the different types of practice, where less than the amounts set out in paragraph 22 will be accepted as a sufficient charge in the particular circumstances. At the same time the Committee recognizes that there will be cases where the amounts recommended in paragraph 22 will be insufficient to provide an adequate fee to the practitioner, and this aspect has caused the Committee to consider the question of the right of practitioners to recover fees from patients. 26. jFees Payable by Patients. —Under section 8 of the Social Security Amendment Act, 1941, a practitioner is prohibited from recovering at law a charge in respect of a general medical service above the fee payable from the Fund for that service. In fact., almost all practitioners operating under the " refund " system and a number of those operating under the " direct payment" system regularly make additional charges,, which are, as a rule, readily paid by patients. Although, therefore, the provision mentioned is not very effective, it is nevertheless a source of dissatisfaction, if not resentment, on the part of a considerable number of the profession. There was general agreement that every general medical practitioner should have the right to charge and recover a fee additional to that payable from the Fund wherever circumstances, in his opinion, warranted it. 27. The Committee accordingly recommends that section 8 of the Social Security Amendment Act, 1941, be replaced by a provision that no medical practitioner shall be entitled to recover fees (whether in respect of general medical services or any

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