Patients are increasingly having to pay top-up fees for private care because of budget cuts in the NHS and long waiting times, according to a report by pressure group Doctors for Reform.

Patients are increasingly having to pay top-up fees for private care because of budget cuts in the NHS and long waiting times, according to a report by pressure group Doctors for Reform.

The group wants the NHS to move from a tax-funded model to a system of social insurance with top-up payments. The report, Free at the Point of Delivery: reality or political mirage?, says that patients are finding sophisticated ways to top up NHS treatment by paying for drugs, devices and investigations privately - sometimes buying them from abroad or on the internet.

The report presents 20 case studies showing that patients are developing sophisticated approaches to purchasing upgrades to their basic NHS care and says these payments are likely to continue in the absence of reforms to health funding.

The group says that top-up payments are happening because of the varying limits of the NHS care package in different places; the limits on NHS quality, including waiting times, delays and service access; and the reduction in costs of some private treatments due to advances in technology and the development of a competitive marketplace.

It has written to all three main political parties and health secretary Patricia Hewitt outlining their concerns that the idea of a free health service is a 'political mirage'.

The report was written by three doctors, including Karol Sikora, professor of cancer medicine at Imperial College School of Medicine. He said: 'The current debate on healthcare funding is strikingly inadequate. Having to 'top up' NHS care is a reality for many patients. But the political debate continues to perpetuate the mirage of a service completely free at the point of delivery.

'We must have a full and frank debate about the future of healthcare funding.'