Birmingham GPs have spoken out against proposals to charge patients up to #20 a time for calling their doctor out-of-hours.
A motion set to be considered by the British Medical Association's local medical committee conference next week says "routine care outside core hours should be partially or wholly provided by a fee charged to the patient".
The charge would apply only to routine appointments made in advance and not to out-of-hours emergencies, which would still be handled by local primary care trusts.
But Dr Andy Thompson, who has served patients in Lozells and Hands-worth for 14 years, branded the proposal as "creeping privatisation".
However, he said out-of-hours services were being abused. "I work on the outof-hours service, in fact I was out for four hours last night, and there is a small, persistent element who call out GPs instead of making an appointment and taking time off work.
"Others decide that a niggling, ongoing problem is suddenly a medical emergency at 2am.
"I am worried that introducing charges like this could put off some patients from using this service at all, probably those that genuinely need to."
Dr Thompson, based at the Enki Medical Practice in Lozells, said that if the proposal was approved by the conference on June 14 and 15, it could create a two-tier system.
"There has to be some sort of safety net to ensure that those who really need this service can still access it," he said.
"I think this creeping privatisation of our health service and I don't think we're far off seeing most elements of the health service being privatised."
The idea for the out-of-hours levy comes amid widespread criticism for GPs over their high salaries.
About a third of their pay now comes from bonuses for meeting targets on objectives such as reducing disease.
Last month it was revealed that GPs' salaries rose almost 25 per cent to an average #100,170 under the first full year of the new GP contract.
Dr Fay Wilson, director of the Badger Medical Centre in Birmingham and a member of the BMA's GP Committee who will be chairing next week's conference, claimed the BMA still believed healthcare should be "free at point of access".
"This is not about charging for out of hours services, it's about access to routine service during the out-of-hours period," said Dr Wilson.
"It's about the people who want a check-up or a blood test or to be weighed at that time, not those who require urgent care. However this motion to introduce charges is contrary to the BMA's belief that healthcare should be free at point of access.
"If patients want better access to their GP services that will mean more doctors, more nurses, receptionists and secretaries working longer hours, and the resources for that have to come from somewhere.
"You can't expect to see your regular doctor at all hours of the day, which is why better access means that relationship becomes disjointed as less value is placed on it."
Other GPs have defended the proposal. Dr Andrew Green, a GP from Hedon, Yorkshire, said people who wanted appointments in the evening could afford to pay for them. He said: "I do not think a fee of #15 to #20 would be exorbitant. This should not be paid for from general taxation."
But Michael Summers, vice-chairman of the Patients Association, claimed the charge could put people's lives at risk.
"The conditions that people suffer from out of hours are just the same as those they suffer from during the day. Why should they have a second-rate service?" he said. "I have been campaigning for some time for the out-ofhours service to be overhauled. People will die otherwise."
A Department of Health spokeswoman said: "We will never change the values of the NHS - universal, tax-funded, free at the point of need. Let's be clear - nobody should have to pay for these services.
"However, a small number of patients do need more flexible access to the services because of their domestic and work commitments and we are looking at the best way of providing this."
