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Dealing with immigrants and eligibility for routine NHS treatment

Question - We recently had several patients trying to register who all gave the same address and date of birth and spoke little English. We were concerned that they were illegal immigrants but were afraid to ask for evidence of their eligibility to NHS treatment for fear of being accused of racial discrimination. How should we deal with this kind of situation?

Everyone is entitled to emergency medical treatment under the NHS, but the full

range of NHS services is not necessarily available to everyone who seeks registration with a GP.

Registering with a GP

The following extract is taken from the Refugee Council website:

'Asylum applicants are not required to show official documentation when they register with a general practice. General practice staff have no right to demand to see an asylum seeker's passport or any other identity documentation. They can get the patient's address from a Home Office letter, bill or similar document addressed to the asylum applicant.

'If an asylum applicant is unable to

register with a GP after a third attempt, they should be advised to contact their local primary care organisation, which can allocate a GP to them.'

Wessex LMCs believe a GP may, and probably should, ask any patient to demonstrate eligibility to NHS treatment before registering, provided this is applied equitably to all patients.

What is not permissible under racial discrimination legislation is to apply this criterion for registration selectively to applicants on the basis of colour or nationality.

The information on the Refugee Council website is helpful, but applies only to genuine refugees and asylum seekers who are entitled to free access to all NHS services. It doesnot apply to recently arrived illegal immigrants and NHS tourists who are notentitled to free access to the full range of NHS care.

As tax-paying British nationals we all pay to support the NHS but the resources are simply insufficient to provide free care for all who might like to take advantage of the system.

The criteria for NHS secondary care are clearly set out in Government documentation and it is not unreasonable that every patient seeking NHS registration is asked to demonstrate their entitlement by providing an item from a possible selection of official documents to prove their eligibility.

The official guidance sets out that a member of staff in secondary care is permitted to ask three questions to establish eligibility for treatment.

 · Have you been living in the UK for the past 12 months?

 · On what date did you arrive in the UK?

 · What is the basis of your stay in the UK?

If further confirmation is required, asylum applicants, those with refugee status or those with exceptional leave to remain (ELR) or exceptional leave to enter (ELE) can show hospital staff their Home Office letter confirming such status has been granted. Asylum seekers can also show their Application Registration Card.

It seems entirely reasonable that primary care staff should be able to establish eligibility in the same way. There is in any case no obligation on a GP to accept any patient on their NHS list, unless the PCO has allocated that patient.

Again the GP must not discriminate on racial grounds, but must have clear criteria to establish why a patient may or may not be accepted ­ for example, patients living outside the practice area will not be accepted.

Another reason would be that the list is officially closed so that only previously registered patients and the children and close relatives of existing patients will be accepted.

It is important that GPs avoid any accusation of racial discrimination. But there has been considerable adverse publicity and criticism in the national media recently regarding GPs who do not check the entitlement of foreign visitors to NHS care.

To deny a genuine asylum seeker care under the NHS is not acceptable, but equally to provide care to illegal immigrants and 'NHS tourists' reduces the scarce resources that are available to all those genuinely entitled to NHS treatment, including genuine asylum seekers and refugees.

Neither Pulse nor Wessex LMCs can accept any legal liability in respect of the answers given. Readers should seek independent advice before acting on the information concerned.

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