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Gold, incentives and meh

GPs to conduct nationality checks in all new patients under health tourism crackdown

Exclusive GP practices with high populations of EU migrants will be asked to check whether patients are eligible for free NHS care under Government pilots due to launch later this year, Pulse has learnt.

The pilots will be rolled out in 10 areas, and will involve GP practices asking all new patients if they have a valid European Health Insurance Card (EHIC), which entitles them to access primary care and certain secondary care treatment without an upfront charge.

Practices will also be asked to collect information on so-called S1 forms from UK state pensioners resident elsewhere in EEA.

Under the EHIC pilots, no patient will be charged for accessing primary care. However, the DH said they were designed to 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.

The pilots come as the Department of Health prepares to launch a consultation on new ways of recovering the costs of primary care from overseas residents. But a spokesperson refused to confirm if this would include any upfront patient charges for primary care.

Under the Immigration Act 2014 only UK residents with ‘indefinite leave to remain’ are entitled to free healthcare, but there is an estimated £200m cost from ‘health tourism’ to the UK every year.

A DH spokesperson told Pulse: ‘We are absolutely committed to improving the way the NHS recovers costs from international visitors for primary care. We’re now planning to pilot different ways of doing this effectively without burdening busy GPs.’

The GPC is working with the DH on the plans, a GPC briefing paper seen by Pulse says under the heading of ‘charging for primary care’ that Government will launch two new consultations in the Spring.

The note says: ‘Two consultations will be launched in the Spring to look further at extensions to charging.’

It added: ‘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. GPC will be involved with a view to starting the pilot as early as possible.’

Last year, the Government shelved a suggestion for charging non-EEA migrants a £200-500 levy upon entry to the UK, or when they went to renew their visa, after admitting it would probably cost more in administration costs than it would recover in charges.

When asked if this position had changed, a DH spokesperson said any plans to extend direct charging for primary care for migrants ‘will require further consultation’.

GPC negotiator Dr Dean Marshall said the pilot was to get GPs ‘used to asking for’ EHIC cards routinely.

He added: ‘We need to pilot it and see how much work it is. It will be extra administrative work potentially but it will hopefully clarify who is and who isn’t entitled to NHS care and clearly there is a huge amount of money being spent in the NHS on people who are not entitled to it.

‘What we have been absolutely clear about is that this isn’t about the GPs becoming a police force and policing the system. It is about the administrative work. Anything we do is about how it can be done with the least amount of burden and of course an electronic solution would be what we are looking for.’

He said that any consultation on recovering money owed by migrants for primary care ‘wouldn’t affect people who need emergency treatment’.

He said: ‘If they need emergency treatment they will get emergency treatment. This is about people who come from other countries and then frequently turn up at practices wanting treatment for a condition that they have been treated for previously.’

But Dr Kailash Chand, BMA deputy chair and a retired GP in Lancashire, said: ‘The health secretary would be wise to concentrate on the major pressures on the NHS rather than being distracted by imposing an unworkable system of charging for health tourism. If this plan comes to fruition it will at best reduce the role of doctors to debt collectors.

‘At worst it will deter them 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.’

This story was changed at 16:00 on 5 February 2015, to reflect that the Government has said health tourism costs the NHS £200m a year, and not £2bn a year as previously stated

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Readers' comments (34)

  • I am going to insist on DNA verification on everyone I come into contact with in my everyday life, following by interpol search of all wanted lists, in case they are a murderer/paedo/terrrorist. You can't be too careful*.

    * Actually you can.

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  • In all this nonsense, there is some sense because surely the UK taxpayer should not be taken for a ride by people who use the system. The problem is large scale but the onus of 'passport control' should not be of overburdened GPs. The guidelines were changed twice- first we had to check identity of every patient registering and then we did not have to.
    UK law gives automatic citizenship to every child born in this country. For nationals of some countries, it is an incentive to come here as a tourist or relation and deliver the baby free, get citizenship for the child and the GP keeps chasing the child for routine jabs as baby has gone back to country of origin.
    Visitors from abroad register with friends and families on short stays and do not declare that they are 'visitors'. How do you expect GPs to control every single person and take responsibility for correctness of each individual case?
    Should we be the ones 'policing' - No, that's asking too much of us.
    Another issue is that treatments not available free in some EU countries - like Fertility treatment- attract patients from EU to UK. Again, these patients show that they are living with friends and families on a permanent basis although you can see that they are difficult to contact; they get results of some investigations from France or Belgium etc and they are unemployed when asked.

    The range of misuse of NHS resources is massive and it is not possible for GPs to confront and control patients - especially not with with the all-round perception that there is no support from GMC or any other quarter if complaints start pouring in from irate relations.

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  • And the complaints do come as Sanjeev Juneja states and indeed there is no support from GMC, NHS England , LMCs or anyone else as no one seems to know what the rules are! We are sticking to our rules if the patient does not like it then they have the choice to go elsewhere!!

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  • I saw a patient trying to register as the receptionist was asking for a proof of address. (They did register him)

    He was homeless. I am pretty sure he did not have a passport - probably did not renew it after his last round the world trip.

    The bottom line is:
    is he allowed NHS medical care?

    Of course he is. What if he had a funny accent? What would you do then?

    The government need to do more than just create headlines, otherwise I will tell them to get stuffed.

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  • i know several men of working age who don't go on foreign holidays and who have never learned to drive. They have no photo ID to prove who they claim to be if they try to register with a new doctor. Plenty of the population don't fall into the neat, ID carrying fantasy that politicians and NHS managers think of. But it's not politicians or the ivory tower NHS managers who have to face the angry patient so its too easy for them to dream up silly schemes.

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  • Just get everyone RFID chipped - then we can just scan the back of their hands . Works for my cat .

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  • This comment has been moderated.

  • "Anonymous | NHS Manager | 05 February 2015 10:57am
    Put forward an intelligent argument for yourself or stop getting involved with these forums. "

    Well your former boss says it's a political stunt. I reckon your peeved because it was your latest ivory tower pet scheme and people at the front line who actually know what they are talking about are rubbishing it.

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  • Are they to pay for their own translator as well? Will they pay extra for extra time taken to investigate and treat ? 10mins won't cover it.Health workers could of course treat privately - for free if people have no money to pay...wonder what the experience of the mysterious pilots is.strange how these pilots don't become known about until they are well underway somewhere. Consultation? What's that!

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  • if we have to decline someone - give them a map and contact number of the local MP and let them sort out the problem.

    it's time we directed some responsibility to the decision makers.

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  • GP surgery isnt border control agency:
    the right way of dealing with this is defining who is entitled appropriately to have NHS care and how can that be translated into practice: Passport / NHS entitlement card.
    Pt should only turn up for registration if they have the right documents eg passport / visa validating NHS entitlement / NHS card (which pts should be able to get by sending relevant documents to a central hub and getting an identity card eg NI number card).
    the GP surgery staff should NOT (I repeat NOT) be asked to check the entitlement.

    Proof of residence can be created by adding the persons name to utility bill (which takes a phone call) and hence should not be allowed.

    for some groups eg homeless pts we will need to help them somehow but that should not stop the above.

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