Baroness Shirley Williams - who claimed to have protected the principle of an NHS “free at the point of need” during the passage of the Health & Social Care Act - suggests today that “There might be a case for at least considering a nominal charge for GP appointments…It might get people to value the service.”

She adds that “You could also have a nominal charge for prescriptions for older people, with appropriate exemptions. An awful lot of people do actually have quite substantial pensions in addition to the state pension.”

The suggestions come in a series of essays published by the Nuffield Trust to mark the NHS’s 65th birthday.

During the passage of last year’s Health & Social Care Act Williams - much loved amongst the party faithful - played a key role in reassuring a deeply unhappy Lib Dem party, telling parliament that “many of us believe, as I do certainly, that the National Health Service should continue to be primarily a public service, that it should be available free of charge and that it should be accessible to all.” She told Lib Dem members “We should be proud of our key role in safeguarding core principles of our NHS.”

At a critical juncture in the passage of the Bill through parliament, Williams also wrote jointly with Nick Clegg to reassure wavering Lib Dem MPs and Peers that thanks to Lib Dem interventions, the NHS would remain “a comprehensive health service financed by taxpayers, accessible to all and free at the point of need.”  

Yet today Williams writes that “I am a believer in everything being free if possible. But rather than see the NHS go down, one might be forced to consider that kind of thing [GP charging].” She suggests that these changes could be considered “but only…with a clear statement by the government of its complete commitment to the retention of the NHS.”

Williams role in the passage of the Bill had already won her the mistrust of NHS campaigners, who particularly doubted her claims that “The bill also now has in place safeguards to stop private providers "cherry picking" profitable, easy cases from the NHS, and we have made sure that private providers can only offer their services where patients say they want them”. The Section 75 regulations passed under the Act just as it came into force, in fact give patients no say as to whether their health services are tendered out or not.

Other contributors to the essay collection, “The Wisdom of the Crowd”, point out that means-testing and extension of ‘co-payment’ in the NHS would be costly to administrate and thus save little - if any - money.

The idea of ending - or means-testing - pensioners’ entitlement to free prescriptions is unlikely to win many votes, even as politicians from all parties equivocate on the extent to which they’ll continue protect universal pension-age entitlements from swingeing benefit cuts after 2015. Although Iain Duncan Smith, Nick Clegg and Ed Balls have all said they want to look at the ‘affordability’ of current entitlements like the bus pass and fuel allowance, few have dared suggest the ending of pensioners NHS entitlement to free prescriptions, though Cameron ally Nick Boles MP floated the idea last year. Currently 9 out of 10 prescriptions issued on the NHS are free.

Proposals to introduce charges for, or otherwise restrict for GP visits have also been hotly denied by most government politicians, who were keen to stress during the passage of the Act that regardless of who took over ownership of health services, it was not ‘privatisation’ so long as it remained ‘free at the point of need’. Even as the contested Section 75 regulations were clearing parliament and the Act came fully into force this April, Jeremy Hunt said that he would ‘oppose’ any new user charges (apart from for immigrants, it would seem).  

Any such proposals would be likely to be extremely unpopular. The Kings Fund found that the public was strongly opposed to means-testing and to the introduction of charging.