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GPs go forth

NHS provision for migrants is 'too generous', say majority of GPs

Exclusive: More than half of GPs believe NHS entitlements for migrants are too generous, with some practices refusing to register patients they believe to be illegal immigrants or failed asylum seekers, a Pulse investigation reveals.

Pulse’s survey of 229 GPs also shows that three-quarters of GPs feel confused and frustrated by the lack of clarity around NHS entitlements and what checks practices should carry out on new patients registering for care.

Some 52% of GPs said they believe NHS provision for migrants is too generous, and only 7% said provision is not generous enough.

GPs are not allowed to discriminate according to a patient’s legal status, with NHS regulations stipulating that overseas visitors ‘whether lawfully in the UK or not’ are eligible to register at practices. However, 38% of GPs said they would not agree to register a person they believed to be an illegal immigrant.

Some 40% also said they would not register a failed asylum seeker whose claim had been rejected.

The rules also state that practices can ask patients to provide documentation when they attempt to register, but they must either ask all patients or none. Around 58% of GPs said their practice routinely asked new patients for identification when registering at the practice, and 27% said their practice did not. However nearly 15% break the current rules by only asking patients ‘sometimes’ for identification.


The findings come as the Government is considering whether to extend charges for NHS treatment for non-residents from hospitals to primary care.

A DH spokesperson said: ‘The review is looking at whether we could introduce [charges] into primary care and how that would work.’

Dr Paul Roblin, chair of Berkshire, Buckinghamshire and Oxfordshire LMC, said it was not unreasonable to review the level of NHS eligibility for visitors.

‘You could argue whether it is fair for visitors and migrants to have entitlement to NHS treatment when that is not reciprocated,’ he said.

‘GPs are expected to practice with limited healthcare funding and if we are using that money for treating visitors, the taxpayer loses out. It may be more appropriate to have a system where we say that if you can’t provide proof of residence, you have to pay for treatment.’

Birmingham GP Dr Vijay Abrol said the burden on practices from migrants had increased in recent years - particularly from EU migrants entitled to NHS care.

‘We have quite a few people coming from places like Poland,’ he said. ‘They don’t speak a lot of English and you have to spend a lot of time with them as someone comes and translates. All their [medical] information is in Polish and it doesn’t make much sense to us. So immunisations for children, for example, become a problem, because we don’t know what they’ve had.”

Dr Abrol said many GPs were frustrated by regulations which require them to treat all patients in their area, regardless of residency, while hospitals require non-residents to pay for treatment.

‘If I send a patient [to hospital], they ask to see their passport,’ he said. ‘It has created a situation where they are suspecting all non-white patients of being illegal.’

‘We can’t refuse anybody treatment. If the hospital tells the patient they have to pay, we don’t get any extra money, but the work involved for us is much more and we still have to meet targets. That situation is unsatisfactory.’

Dr Richard Vautrey, GPC deputy chair, said it was important to keep the problem in perspective: ‘The reality is the vast majority of people who are asking to see a GP are doing so appropriately.’

But he advised GPs to ensure they were following NHS rules.

‘If GPs ask for evidence of immigration status or residency from one patient, but not every patient, they could be deemed to be applying discrimination. So either they need to do it for every patient or do it for none.’

Dr Les Goldman, a Bradford GP who runs a primary care service dedicated to treating asylum seekers and refugees, said migrants often found it difficult to register with a GP because of barriers such as documentation and lack of English skills, not to mention a lack of familiarity with the UK health system and having to cope with traumatic life experiences.


He said GP practices were not prejudiced, but in some cases were struggling to deal with an influx of migrants.

‘You might 20 asylum seekers register in a fortnight, and a GP just can’t cope. It isn’t malice or prejudice. It’s just that your capacity to deal with it is limited.’

Readers' comments (19)

  • ‘We have quite a few people coming from places like Poland,
    "If I send a patient [to hospital], they ask to see their passport,’ he said. ‘It has created a situation where they are suspecting all non-white patients of being illegal"

    a) Non-white patients from Poland? A rarity I think
    b) I hope you have evidence, I'd hate to think this was just hearsay.

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  • I agree with Paul Roblin. The NHS visitors provisons needs a review. This means including those coming from EU countries. The NHS is at breaking point depsite the goverments positive spin and being in denial. What will happen to the NHS when Rumanians and Bulgarians are allowed to come here
    I certainly cannot get a free medical treatment abroad in a EU country without paying up front despite the reciprocation.
    I feel we are a soft touch and the blame lies with the goverment for being spineless

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  • Targeting people who 'look' like immigrants and sounding them out for special interrogative cross examination has the potential of adversely affecting the patient experience and the patient - doctor relationship with minorities. A believe that a patient is an illegal immigrant is usually influenced by racial and ethnic prejudices in my experience. Profiling patients this way and subjecting minorities to MI5 type interrogation will only help to further create racial animosity and tension in the UK. The responsibility of the GP does not include immigration control. Drs must desist from acting as an extension of the UK border agency if they are to improve relations with their patients from minority ethnic origins and European citizens. I hope they give a damn about their non-whites and EU patients. Assuming that these people are indeed illegal, does it not make sense to register them, provide treatment and then recover cost rather them sending away only to choke our GPs A&Es?
    By refusing to register a patient, GPs are by implication refusing treatment. Refusing treatment to people they 'believe' to be illegal immigrants is pure bigotry.

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  • I'm afraid politicians are to be blamed for this.

    I recently refused to register a visitor from non european country. They wanted all the treatment under NHS whilst on visitting visa (i.e. not permanant) for 12 months. The directive from our local SHA? I must register the patient as they are INTENDING (not even stayed for 6 month yet!) to stay for more than 6 months.


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  • Can some one tell me why we have any responsiblity for primary care for those here on visit visa's. i lived and worked abroad for 12 years where I was not entitiled to any free health care (primary or urgent) I had to pay for prvate health care and indeed had to prove I had this to remain working there. Our system is breaking - we need to sort this

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  • Sorry Josua Tedham GPs have to live in the real word.
    Out of interest are your a prospective parliamentary candidate?

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  • In the mean time I continue to have no recourse to social care as I was not British by birth - despite having lived in the country for over 20 years and paid tax for the last 13 years......

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  • Annon 11:20 THe govt has done deals with some countries to allow for reciprical access to each others health care systems. I suspect these were agreed years and years ago probably for policial smooching reasons.

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  • All visitor to this country should have to provide evidence of medical insurance prior to entry to this country. Just as I have to do when I go abroad.
    GPs should also be informed with which countries we have reciprocal arrangements, and forms to send to the DHS so that the Department can claim back from these countries.
    General Practice should not be free for any visitor as it is not free to any UK citizen when they go abroad.
    Politicians and managers should be supporting GPs and not using the easy way our by saying GPs have to see all visitors.

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  • It's disgusting. Quite frankly I believe that if you are not born and bred here in the UK then you should PAY the NHS for your treatment, regardless of what it is for; (Emergency treatment, hospital stay, operation, dental, optical or audiological treatment. Why should England pay for the rest of the world? Isn't it bad enough that England pays for Wales and Scotland's subsidiaries????

    Get it sorted Mr Cameron et al!

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