Should NHS Patients Pay to Message Their Doctor?

The New England Journal of Medicine has published a Clinical Decisions piece examining whether healthcare providers should bill patients for messages sent through online patient portals. The article, shared by the journal’s official account, sits under the hashtags #HealthPolicy and #MedicalPractice — signalling it is aimed squarely at clinicians and health system planners rather than the general public.

Patient portals — secure online systems that let people contact their GP or hospital team, view test results, and manage appointments — have grown rapidly across both the US and UK. In the NHS, platforms such as the NHS App now allow patients to send messages directly to their GP practice. So far, NHS messaging remains free at the point of use, in line with the founding principle that care is free when you need it.

The US context is different. American insurers and health systems have begun allowing doctors to charge for portal messages that require clinical judgement — a response to what many physicians describe as an unsustainable volume of digital admin. The NEJM piece frames this as a genuine ethical and practical dilemma, not a settled question.

It’s a tension worth watching. If digital messaging reduces unnecessary GP appointments — which NHS England has actively encouraged — charging for it could deter patients from seeking advice early, potentially leading to more serious problems down the line, a concern raised by critics of charging models.

The NHS has not proposed any charging model for patient portal messages. NHS guidance continues to direct patients to use NHS 111 for urgent medical queries, their GP for non-emergency concerns, and 999 in an emergency.

For now, the NEJM debate is a US-focused policy question. But as the NHS App expands and digital contact with clinicians becomes routine, the underlying question — who bears the cost of a doctor’s time online — is one UK health policy will eventually need to answer.