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BMA updates GP guidance amid Government crackdown on health tourism

The BMA has updated its guidance to GPs on treating overseas patients as the Government has intensified its campaign on recovering costs of treating ‘health tourists’ in secondary care.

Based on new guidance issued by the Department of Health on the charging of hospital patients, the BMA’s guide aims to clear up confusion among GPs, including which overseas visitors they must treat free of charge, who they can decline treatment and who they may charge to treat privately.

The key points include advising GP practices that they must treat, free of charge, any overseas patient in their area who needs emergency care, including if this is caused by a pre-existing condition which has become exacerbated during their UK visit.

Practices are also reminded they must have procedures in place to ensure these patients can be treated, for example by registering them as temporary residents.

They are also reminded not to discriminate against any patient based on race or appearance, so if they do ask for proof of immigration status, they must do so for all patients.

However, the guidance also clarifies that practices may turn away overseas visitors for care subject to their own discretion if they do not need urgent treatment. Alternatively, in such situations, they can offer care on a private basis and may charge a fee for doing so.

The BMA’s guidance said: ‘When a person does not require emergency or immediately necessary treatment, practices have some degree of discretion under the contract regulations about whether to register the person…

‘Any person who does not require emergency or immediately necessary treatment and has not been accepted onto a patient list or accepted as a temporary resident can still be treated by a GP on a private basis, for which they may be charged. Alternatively those persons can be directed to contact the appropriate local body, who can advise on what services are available locally.

It added: ‘We advise practices to use their discretion and consider the individual circumstances of an overseas visitor who cannot provide documents that they would normally require for patient registration.’

Since April, hospitals are advised to charge ineligible migrants at 150% of the tariff price for secondary care however the DH guidance says GPs ‘should not be discouraged’ from referring any patient for treatment on the basis they may have to pay.

The DH is still working up plans for implementing charging of overseas migrants for primary care and it is also piloting models for how GPs can help inform secondary care of where a patient may not be eligible for free treatment, including asking all new patients for EHIC cards.

BMA key pointers to GP practices on treating overseas visitors

Practices:

  • have a contractual duty to provide emergency treatment and immediate necessary treatment for up to 14 days to any person staying in their practice area, including for pre-existing conditions exacerbated during UK stay
  • should have procedures in place to identify and treat these patients, registering them as a temporary resident being one option
  • have discretion about whether to register the person if they do not need emergecny or immediately necessary treatment
  • must not turn any patient down due to race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition
  • cannot demand proof of identity or immigration status to register but can ask them to produce it voluntarily if this is done for all patients
  • are advised by BMA to use their discretion and consider the individual circumstances of an overseas visitor who cannot provide dcuments that they would normally require for patient registration
  • can treat patients who do not require emergency or immediately necessary treatment privately, and may charge them to do so.

Source: BMA

Readers' comments (10)

  • I find the BMA guidance puzzling. It makes no differentiation between EU and non-EU citizens seeking medical treatment here. For years we have been told that EU citizens are entitled to the healthcare of the country they are visiting, in other words free when they visit here. SInce the BMA makes no mention of EU citizens it seems we are now able to charge them private fees if they are not an emergency or Imm Nec?

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  • Re "SInce the BMA makes no mention of EU citizens it seems we are now able to charge them private fees if they are not an emergency or Imm Nec?"

    Yes .This has always been the case . You can register them as TRs but do not have to and can treat them privately unless an emergency. We have been for years.

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  • Er. Basically it is saying see the person, and if you don't you will spend 1 year being interrogated by the big brothers.

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  • GP Partner at 3:16, you are breaking the NHS rules by not registering them and by charging them. If your list is open you can not refuse to register them and give them free treatment for everything.

    The BMA guidance is useless. It says that if we don't register them as NHS we can charge them but it doesn't say on what grounds we can refuse to register them if our list is open. Nowhere does it explicitly state that being from overseas is a legitimate reason for refusing to register someone as NHS when your list is open. In fact the NHS explicitly states that we can not refuse to register them as NHS, see below

    According to the NHS, we must treat them all for free for anything, not just emerg and Imm Nec, and that there is no legal ground for refusing to register an overseas visitor for free treatment

    http://www.nhs.uk/nhsengland/aboutnhsservices/uk-visitors/Pages/accessing-nhs-services.aspx

    "You can also register as a temporary patient with a GP practice when you are in the area for more than 24 hours and less than three months. It is up to the GP practice to decide whether to accept new patients or not. Treatment will be free of charge."

    And

    http://www.nhs.uk/chq/Pages/1087.aspx?CategoryID=68&SubCategoryID=162

    "Registering with a GP
    Under current rules, anyone can register with a GP practice in England and receive free primary care. A GP practice can only refuse an application to join its list of NHS patients where it has reasonable grounds for doing so: for example, if their lists are closed to new patients, the applicant lives in a different practice's boundary area, or in other rare circumstances.
    Once registered as a NHS patient, primary care services provided by a GP practice are free, "

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  • However, the guidance also clarifies that practices may turn away overseas visitors for care subject to their own discretion if they do not need urgent treatment. Alternatively, in such situations, they can offer care on a private basis and may charge a fee for doing so.

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  • GP partner @ 12.50

    Not according to the NHS you can't, from the NHS website advising the public and visitors -
    "A GP practice can only refuse an application to join its list of NHS patients where it has reasonable grounds for doing so: for example, if their lists are closed to new patients, the applicant lives in a different practice's boundary area, or in other rare circumstances"

    The BMA guidance does not state what those rare circumstances are and indeed itself says -
    " In reality, this means that the practice’s discretion to refuse a patient is limited"

    I challenge anyone to show me where it states that "visitor from overseas" is a legitimate reason for refusing registration to someone who does not require emerg or Imm Nec treatment.

    In other words this "crackdown on health tourism" amounts to nothing in general practice, the NHS explicitly states that we must register them and treat them for free for any condition and the BMA so-called guidance does not challenge that.

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  • However, the guidance also clarifies that practices may turn away overseas visitors for care subject to their own discretion if they do not need urgent treatment. Alternatively, in such situations, they can offer care on a private basis and may charge a fee for doing so.

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  • GP partner @ 3:15

    The BMA is not the authority on this, the NHS published rules make it quite clear that -
    "A GP practice can only refuse an application to join its list of NHS patients where it has reasonable grounds for doing so: for example, if their lists are closed to new patients, the applicant lives in a different practice's boundary area, or in other rare circumstances"

    Furthermore the BMA guidance does not say what you claim that practices may turn away overseas visitors at their discretion. What the BMA guidance says is -
    "practices have some degree of discretion under the contract regulations about whether to register the person. ................. In reality, this means that the practice’s discretion to refuse a patient is limited."

    At no point does the guidance state that being a visitor from overseas is legitimate reason in NHS rules for refusing to register them as NHS.

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  • Talk about Left Hand - Right Hand (BMA -NHS)

    No wonder there is so much confusion for Staff as well as Patients.

    First of all GP's don't do "Emergency" care in the same way that A&E don't (or shouldn't) do General Medical Services.

    We are giving patients the excuse they need to clog up A&E, by not being clear on this.

    Patient: "I went to A&E because my GP had no appointment for my "emergency" care.

    Doctor: "And what was your emergency, Mr Snodgrass?"

    Patient: I've had this runny nose and sore throat for 4 days now!!"


    And, in order to avoid discrimination, we must ask "ALL patients for their immigration status............................"

    Aahh, Good morning Mrs Postlethwaite, nice to see you again, now, you may find this a strange question, having been a patient here for the last 65 years, but in order to not upset any foreigners who may be looking for a freebie on the NHS, can you tell me, are you a legal immigrant or not?"

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  • You can refuse an application to join a list on the basis that an overseas visitor lives outside the practice boundary.

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