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At the heart of general practice since 1960

GPs must not be asked to police EHIC cards

Dr Kailash Chand writes

Yesterday, the Daily Mail ran a story from a Hungarian journalist who came to England, generated various questionable documents, went to a GP practice, registered, obtained an NHS number, went on line got an EHIC (E111) card, went back to Hungary and used the card to obtain medical treatments that, it is alleged, could be charged to the British taxpayer.

The Mail is now demanding tighter procedures, so the Department for Health has said it will look into what happened, and a rightwing thinktank has chimed in too, saying that the UK could be financing free travel insurance for EU citizens.

EHIC rules

This is patently ridiculous and, is meant to fuel the immigration debate. The fact of the matter is that, you do not have to be British to get NHS care neither a British taxpayer. What an EHIC card entitles you to is the services available to home citizens. Millions of us use them when we go on holiday. If one needs treatment in any EU state including Switzerland: you’ll get the treatment a EU resident will get.

The intention of the scheme is to allow people to continue their stay in a country without having to return home for medical care. As such, it does not cover people who have visited a country for the purpose of obtaining medical care, nor does it cover care, such as many types of chronic diseases, which can be delayed until the individual returns to his or her home country. It only covers healthcare which is normally covered by a statutory health care system in the visited country.

So from the standpoint of the individual it would be an utterly pointless fraud since all EHIC card would entitle you to would be what you are entitled to anyway.

There are plans to start an EHIC pilot in primary care, to encourage the collection of EHICs, increase identification of chargeable patients and increase the engagement of GPs with the cost-recovery programme generally. But doing that nationally would add hours to a GP’s workload to get authorisation for EHIC card, register the patient and initiate the process that issues an NHS number. So if this plan comes to fruition it will at best reduce the role of doctors to debt collectors.

At worst it will deter GPs from registering migrants and asylum seekers as well as setting up a new system of charging that could be extended to others. Tampering with the core principle of the NHS , that it is free at the point of delivery, runs the risk of loading scarce resources on a minority issue while the more meaty challenges remain unresolved.

The GP staff do their best to assist this procees but receptionists are not the immigration police. They already have enough on their plate and are struggling to meet the needs of their patients without taking on more work.

GPs’ job is to care for the patients who need care, and not to act as border controls officers.

Dr Kailash Chand OBE is the deputy chair of the BMA, and a retired GP

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Readers' comments (3)

  • Receptionists are not immigration police but they are employees of businesses who will sustain a loss from treating those not entitled to NHS care. Sorry, but Tesco would not give free food to immigrants and nor would the executives of the charities supporting them work for free - the job of a GP is to care for those for whom they are contracted by the NHS to care only. There are many who may wish to work pro bono, but that is their choice, not an obligation.

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  • @8:43

    While your sentiments are understandable, I don't see any reason to suspect that ineligible patients are a significant drain on the resources of any practice I've worked at.

    I think from a purely business perspective, setting up systems to "police" eligibility must be a pretty marginal benefit, and a correspondingly low priority.

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  • Dr Chand is quite correct. The changes to the EHIC rules 1st July 2014 would appear to make the Daily Mail's stunt pointless especially as Hungary has a good NHS of its own. The article probably sold more copy though.....
    However it does raise another point, since July 2014 travellers are only entitled to the level of free healthcare a citizen of that country would normally receive, any copayments are no longer covered by the scheme. This is blatently unfair. Ordinary residents of the UK receive free NHS care because they pay a substantial amount annually via tax, it's a similar storey in Germany where state health care costs on average 13% of earnings. This is not the case in France where copayments are between 25-50% of the cost nor in Cypus where the state only covers about 36% of health costs. Therefore a Frenchman visiting the UK gets free healthcare but a Brit visiting France/Cyprus wil have no pay a non-refundable copayment. My view is that the whole scheme is completely inequitable and should be abandoned. If you can afford to travel abroad you should be able to afford travel insurance. I do disagree with Dr Chand on one point. Given the pressure on the NHS I believe that every employee or contractor within the NHS has duty to ensure that NHS care is not freely given to those who are not entitled. Furthermore I believe that the Government should support front line staff by performing checks behind the scenes when a patient registers for care. Given the amount of financial checking and charging that now goes on with the internal market I think the first question should be "is this patient entitled to free NHS care".

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