GPs forced to register illegal immigrants after threat of legal action
Exclusive GPs are being forced to register and treat known illegal immigrants because of the threat of legal action, a Pulse investigation reveals.
A GP practice in Essex has told how it was made to re-register a family of migrants without permission to stay in the UK after pressure from human rights lawyers, even though the local hospital refuses to accept referrals for them – and the solicitor involved has claimed similar success in ‘scores' of other cases, including where people have come to the UK illegally.
The case, at a practice which asked not to be identified, highlights mounting confusion over the responsibilities of GPs in treating migrants who do not have leave to remain in the UK, or have been refused asylum status. While Department of Health guidance permits GPs to treat failed asylum seekers at their discretion, a Pulse investigation in July found one in ten primary care organisations place practices that do so under investigation.
Last year, a family from Nigeria registered with the Essex practice, with each patient providing an NHS number. But when the practice attempted to make a referral to the local hospital, the hospital wrote back saying they were not here legally and were not entitled to treatment.
The practice subsequently checked this with the UK Border Agency, which confirmed the family's application for asylum had been refused with no right of appeal in May 2010, and then again in August 2010. After the family confirmed this, the practice removed the two adults, but not the children, from its list.
GPs at the practice then received a letter from Pierce Glynn, a firm of human rights lawyers in Bristol, which challenged the decision under the 2004 GMS contract regulations and the Equality Act 2010, and threatened judicial review. Similar challenges were made to the PCT, for not assigning the family to another practice, and the local hospital, for refusing to treat the family and for disclosing their immigration status to the GP.
The practice manager told Pulse: ‘Someone at the PCT read the letter and panicked. I started getting lots of phone calls from the PCT saying we should not remove them, and if we don't take them back then they could take contractual action.'
‘I looked everywhere to find anything written about what GPs should do with illegal immigrants, but there is nothing.'
After taking advice from its medical defence organisation, the practice re-registered the family.
‘The woman is unwell and needs treatment at the hospital, which is refusing to treat her,' the practice manager said. ‘Where can we refer her if she has no money for private treatment?'
‘And what do I do now about people who come in on six-month or visitors' visas and stay on illegally? Do we just register everyone who is illegal?'
Adam Hundt, a partner at Pierce Glynn, told Pulse: ‘There's a perception about regulations in relation to primary care, and that baffles me.'
'In fact, there are no rules that are immigration specific here are no eligibility criteria for GP registration. If there is no law that says it's OK [to refuse registration], then it's not OK, and is a breach of GMS or PMS regulations.'
‘I have handled scores of cases involving GP registration and none have ever gone to court. A letter is enough.'
A spokesperson for the Migrants Health Network said: ‘The GMS/PMS regulations do allow GPs to refuse to register someone on reasonable grounds, e.g. the patient is not living in the GPs catchment area, or their list is closed. However, they must not discriminate by refusing to register on grounds of health status, race, gender, sexual orientation or social class.'
According to the Department of Health, immigration status is not considered reasonable grounds to refuse to register someone as an NHS patient in primary care. However Section 175 of the NHS Act 2006 allows hospitals to charge non-UK residents for some secondary care procedures. In 2010 the legislation was amended to allow immediately necessary or urgent treatment to be provided in advance of payment for failed asylum seekers.
GPC negotiator Dr Chaand Nagpaul said: ‘GP practices should not be policing the eligibility of patients for NHS treatment, or whether they are failed asylum seekers.'
‘The regulations allow GPs discretion to register accordingly. They can register a patient as a temporary resident or an immediately necessary registration, in which case you can restrict services to emergency treatment.'
‘In this case it was a normal registration. If you remove a patient after you register them normally there's guidance on the reasons you can remove someone, and GPs have to give a good reason for removal.'
However, Dr Nagpaul would not comment on whether immigration status could ever be a valid ground for removal.