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GPs to charge migrants for all routine and emergency care unless they pay NHS 'levy'

GPs should charge non-EU migrants for all primary care ‘at the point of delivery’ - including emergencies - unless they have paid a new levy of between £200 and £500 per year, a Government consultation suggests.

In a major shake-up of the entitlement non-EU migrants have to NHS treatment, the Department of Health proposes all those in the UK for a ‘limited period’ would have to opt-in and pay the levy for free NHS treatment upon entering the country.

If they do not, then the Government suggests that they should have to pay for all primary care treatment up-front, although the costs from emergency care in hospital would be recouped later.

In order to do this, the DH proposes that NHS numbers and GP records should ‘differentiate chargeable and exempt persons’ and there will be a new system where initial ‘NHS registration’ is a separate process from registering with a specific GP practice.

The DH says the plans are provisional - and it would also consider a model of private health insurance - but that it favours introducing the levy.

The proposals have surprised the GPC, who said it raised ‘deep ethical concerns’ and would place GPs in an ‘inappropriate position’.

The document says: ‘We propose to restrict entitlement to free NHS treatment to those non-EEA nationals with a permanent relationship with the UK. Building on this we propose that those who come for a limited period should make an explicit contribution to the costs of their healthcare unless or until they are given indefinite leave to remain.

‘These temporary migrants might pay a migrant health levy on entry to the country, or be required to hold insurance to cover the costs of their NHS treatment.’

It adds: ‘Temporary migrants paying the migrant health levy would have access to primary care without further charge. However for other short-term migrants who request non-emergency access (perhaps to monitor current chronic conditions while visiting, or for illegal migrants) a direct charge could need to be levied.’

It suggests that GPs could charge a payment per consultation or other service, an annual service fee or another standard fixed fee. It also says that there may be ‘incentives’ introduced for GPs to collect the charges.

The consultation document says: ‘There should be an appropriate and integrated set of new financial and other contractual incentives to maximise the number of patients who are appropriately charged, and to maximise revenue recovery from appropriately charged patients.’

However the Government has admitted it doesn’t know the actual cost of ‘health tourism’ and alongside the consultation has commissioned an ‘audit’ of NHS use by visitors and temporary migrants which will collect information directly ‘from staff on the front line’ and report in the autumn.

Health secretary Jeremy Hunt said: ‘We are clear that the NHS is a national health service not an international health service and I am determined to cut out abuse in the system.

‘The NHS is a national treasure and we need to work with the entire health system to develop plans and make sure it is sustainable for years to come.’

But the GPC condemned the plans, saying they struck ‘at the heart of the ethical duty of the doctor’.

GPC negotiator Dr Chaand Nagpaul said: ‘I think it would be wholly inappropriate to put GPs in a position to charge patients who have urgent health needs.

‘The danger is that patients with serious illnesses will not present to a GP. They may actually become more ill and incur greater cost to the NHS through requiring hospitalisation or emergency treatment. It also incurs a risk of spreading illness in local communities, for example tuberculosis.

‘I thought that they would still say that GPs should charge patients for routine healthcare, but that it specifically says that urgent care should be charged is the bit I find really striking at the heart of the ethical duty of the doctor. That is extremely worrying and raises deep ethical issues.’

While the consultation specifically focuses on the NHS in England, the Government said some immigration aspects are applicable across the UK, with a separate discussion to be held with the devolved health administrations in Wales, Scotland and Northern Ireland. The legislative changes will be put through as part of the Immigration Bill that is currently going through Parliament.

Readers' comments (23)

  • ‘I think it would be wholly inappropriate to put GPs in a position to charge patients who have urgent health needs.'

    The GPC need a reality check. Visitors have to take responsibility for their health care, as we do when we travel abroad. If true emergency will be blue light to A+E and hospital can bill on their compulsory insurance. Having worked abroad for 6 years I have no issue with charging visitors. In the country I worked we used to charge visitors double the local rate as a Robin Hood system

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  • Dr Chaand Nagpaul don't you think that the inhabitants of this island are entitled to any ethical considerations when their hard earned money is paying for the rest of the world?

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  • What planet do the members of the GPC live on? It has been a very long time since they have represented the views and ethics of doctors.

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  • We should charge everybody not just foreigners

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  • The devil is in the detail. In principle, asking those who do not contribute to the running of the NHS to pay for treatment must be a step in the right direction. The execution however may end up victimising some citizens who 'look' like non-EEC Citizen. Steps must therefore be taken, if implemented, to ensure that British citizens who are of black or Indian are not targeted and subjected to undue and disproportionate scrutiny and harassment in the implementation of the levy. We have over the years witnessed the abuse of police stop and search powers on black and ethnic minorities because they fit the stereotypical biased view of the profile of a criminal.
    I will hate to be denied treatment or my treatment delayed due to unnecessary scrutiny because I look and sound like a non-EU citizen.
    It will also be unfair to levy all those non-eu citizens who enter the UK regardless of whether they access the nhs care system or not. Perhaps the annual levy should be collected at first access for each year. Incidentally, apart from a few countries, such as the US, most of the category of visitors who will be affected come from poor countries.
    The fundamental principle must involve isolating GPs from having to deny patients treatment. The policing of the levy should be the responsibility of a specialist administrative agency operating under the remit of say Monitor (the health watch org).
    Treatment must not also be denied. Rather, processes should be instituted towards cost recovery after the treatment has be given.

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  • Have non-EU nationals to pay for treatment? I'm a non-EU on a temporary visa and working in the NHS, contributing to it by working in it and paying my taxes. And I should have to pay upfront for medical treatment? I can understand for people coming here and not paying any taxes or visitors having free access to the NHS without paying taxes - they should pay. If you travel to a foreign country and get ill, you will have to pay for your medical treatments and that should be the same here. g

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  • @above.According to the proposals the GPs ARE isolated from denying treatment.The non EUs will be paying a levy to the centre and all subsequent care will be free.If they haven't paid then we can charge them.What haven't you understood?

    My main gripe is that £200 is a ridiculously low sum.I strongly suspect the government has done trade deals with the emerging markets in exchange for lax border controls and use of British "hospitality"

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  • 200 is nothing. Whose idea was it.

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  • A lot of visitors will be happy to pay 200 pounds to buy a year of any treatment. much cheaper than private health care

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  • Good! This has been a long time coming. There are far too many people not entitled to NHS care sponging off the British tax payer.

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