Patients should be charged for GP appointments and A&E visits, Sajid Javid has said, as he called the present model of the NHS “unsustainable”. The former health secretary said “extending the contributory principle” should be part of radical reforms to tackle growing waiting times. In an opinion piece for the Times, he called for a “grown-up, hard-headed conversation” about revamping the health service, noting that “too often the appreciation for the NHS has become a religious fervour and a barrier to reform”. The prime minister, Rishi Sunak, is not “currently” considering the proposals, Downing Street told the newspaper. During his campaign for the Tory leadership, Sunak set out plans to issue £10 fines to patients who miss GP or hospital appointments. But he backtracked on the pledge after it was widely criticised by health leaders, signalling the controversy surrounding any reforms that could threaten the principle of free NHS care at the point of need. Javid said the NHS’s only rationing mechanism – to make people wait – should be replaced by means-tested fees, while “protecting those on low incomes”. “We should look, on a cross-party basis, at extending the contributory principle,” he wrote. “This conversation will not be easy, but it can help the NHS ration its finite supply more effectively.” He pointed to Ireland’s “nominal” €75 (£66) fee for attending an injury unit without a referral, and £20 fees charged for GP appointments in Norway and Sweden as possible models. “Too often the appreciation for the NHS has become a religious fervour and a barrier to reform,” the Bromsgrove MP also said. “We need to shake off the constraints of political discourse and start having a grown-up, hard-headed conversation about alternatives.” Javid, who will not stand at the next election, argued that “the 75-year-old model of the NHS is unsustainable”.