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Independents' Day

GPs must provide routine care to tourists, says new BMA guidance

Exclusive GP practices should provide routine care to any patient - including tourists - even if they are unable to show proof of address or ID, new BMA guidance has said.  

The BMA clarified the guidance after acknowledging that there was confusion among GPs about which patients they should register and who could be privately charged, with variations in approaches across the country.

The new guidance - which the GPC says will be endorsed by NHS England - makes clear that even tourists who are staying in the area temporarily should not be charged either for emergency or routine care.

However, the clarification comes as the Department of Health is preparing to launch a consultation on extending charging for NHS services from overseas patients in general, which could include them being charged for accessing GP services.

The new BMA guidance says: ’There is no contractual duty to seek evidence of identity or immigration status or proof of address. Therefore practices should not refuse registration on the grounds that a patient is unable to produce such evidence.

’Anyone who is in England is entitled to receive NHS primary medical services at a GP practice and applications for registration for any patient in England must be considered in exactly the same way, regardless of country of residence.’

GPC deputy chair Dr Richard Vautrey said that the guidance means GP practices ’do have to treat tourists seeking general practice care if they are in their area and they have an open list’.

When asked whether this included routine care, he added: ’Yes, they’d just need to show that they were in the practice area.’

He said: ’It does not matter what you live in, or with whom, as long as the patient says they live within the practice boundary then the practice should see them under the current registration arrangements: immediately necessary care for those in the area that day; temporary residents if staying for up to three months; or full registration if beyond that.’

But he said this would not amount to practices working for free, as they ’will receive full global sum fees for fully registered patients’.

He added: ’What we’ve been expecting for some time is guidance from NHS England on registration arrangements. We expect that this will make it absolutely clear that all people in the country, including tourists, can access free GP services.’

An NHS England spokesperson said: ’We are currently working on guidance that reiterates the current regulations around patient eligibility and registration and will publish it in due course.’

Under the Immigration Act 2014, only UK residents with ‘indefinite leave to remain’ are entitled to free healthcare - including GP services.

So far, charging has only been implemented for elective secondary care but The Times has reported that the Government is looking at also charging for emergency care.

A DH spokesperson told Pulse a consultation on extending the charging regime will be launched in around a month’s time.

The spokesperson said: ’International visitors are welcome to use the NHS, provided they pay for it — just as families living in the UK do through their taxes. This Government was the first to introduce tough measures to clamp down on migrants accessing NHS care and have always been clear we want to look at extending charges for non-EEA migrants. No-one will be denied urgent treatment and vulnerable groups will continue to be exempt from charging.’

Dr Vautrey said the GPC was ’expecting a Government consultation on extending charging to elements of primary care’.

A BMA spokesperson said it has updated advice because ’this has long been an area of confusion for GPs, largely due to the absence of clear guidance from the DH and NHS England’.

‘Therefore while the BMA’s existing guidance remains the same, we have made it clearer for doctors to understand. We are expecting NHS England to clarify its own guidance shortly to avoid any confusion on this issue in the future,’ they added. 

Pulse revealed earlier this year that the Government plans to ask GPs to request to see EHIC cards for all patients in areas with a high population of visitors from the EU. These pilots would test the feasibility of practices routinely asking patients for documents to enable the NHS to recover the costs of primary care from their home countries in future, the DH said at the time.


Readers' comments (36)

  • Azeem Majeed

    Yet another reason why GPs need to move away from capitation towards an activity-based contract.

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  • Fully agree with above. The only problem with activity based is it would be contract awarded to the lowest bidder and like OOH it would be a race to the bottom soon.

    A compromise would be capitated at present GMS levels for first 2 appointments and extra appointments after that would have to be paid by the NHSE. After all the national avg was 2.5 consults/person/yr when the nGMS contract was done in 2004.
    I suspect the NHSE don`t have money for same!
    Germany does a voucher method and seems to be working Ok so far.

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  • Azeem, capitation funding is fine for this as long as no-one is demanding additional appointments for tourists (which they aren't). 'All' that this means is that a tourist will take an appointment slot otherwise available to registered patients. Not sure that would be acceptable to UK taxpayers, but that's another issue.

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  • So in effect any one could be a "tourist"? Anyone could be treated whether they are from abroad or down the road. So there would be no need to be registered with any practice at all for anyone in the UK????

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  • The situation is worse than Pulse is reporting.

    1. The GP and business will be working for nothing. Few visitors from abroad are here long enough for full registration so will be TRs or INs, and we do not get an NHS fee for them. So GPs have to see them and not be paid for it, that just rubs salt in the wound.

    2. We have sought and received clarification from the GPC that the visitors from abroad are to be given NHS prescriptions which they can then get dispensed by the pharmacy under normal NHS rules, i.e free or for the prescription fee, and thus foreign tourists can get very expensive drugs at UK taxpayers expense.

    This whole situation is obscene, that foreign tourists can make full use of GP and prescription services for free, that GPs have to work for no pay, that the UK taxpayer is being ripped off, and it's no good Govt ministers bleating that they are looking into it, they have had decades (health tourism to the NHS has been a problem since it started) and no Govt has done anything sensible about it, the Tories have been in power for most of the years since the NHS was started so there is no reason to believe they are suddenly going to fix this problem now.

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  • If I demanded free care in many other countries as a tourist, I would be told to **** ***.
    Clearly then I don't need medical insurance for say the USA??

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  • I agree with 11.17. No other country provides free care to their own residents, forget tourists. This is totally unacceptable and in times of crisis, is not going to be helpful for already struggling GP surgeries.

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  • The Global sum? Don't make me laugh. Dr Vautrey is sounding like the dissemblers at the Department by claiming "it is included in the baseline Global Sum" -like so much else we provide, in effect, for nothing.
    And when did anyone get free medical treatment in the EU or elsewhere- even if one flashes the EHIC?
    Why should overseas visitors be entitled to tax funded services especially for non-urgent conditions and forgotten medication.
    "Could my mother have 4 inhalers as they are so expensive in …."?

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  • There's also no contractual obligation to ask any patient how long they will be resident in the area, so just register them fully.

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  • The global sum comes out a fixed pot so GPs will essentially be working for nothing, more so for short stay tourists where the patient can't be registered. I agree with Azeem that it is time activity was funded rather than capitation as the number of contacts with all patients is going up exponentially so being paid for a registered list is not fit for purpose. The GPC is also unfit for purpose advising GPs to work fo nothing in the present perilous state of GP

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