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GPs 'could do more' to help NHS recover costs from overseas patients, MPs say

GPs ‘could do more to help’ the NHS recover costs from overseas patients who are not entitled to free treatment in other parts of the system, according to a new report by MPs.

The Commons Public Accounts Committee recommends that the Department of Health should issue guidance by this summer setting out how GPs can help in this role – despite it not being a contractual obligation.

But the RCGP said the report’s recommendations undermine ‘crucial trust’ between doctors and patients and said politicians should stop ‘perpetuating the idea that GPs should assist with border control’.

The ‘NHS treatment for overseas patients’ report says that NHS hospital trusts have been ‘recovering much less than they should’ from overseas patients, despite it being a statutory duty for 30 years.

This improved after the DH introduced an overseas visitor and migrant cost recovery programme in 2014 - £289m was recovered in 2015/16 compared with £97m in 2013/14.

But the report says this was not down to trusts implementing the ‘chaotic’ rules any more effectively, adding: ‘The Department and the NHS are still a long way from meeting the target to recover up to £500 million a year by 2017–18.’

The PAC says it is ‘not confident’ that the DH and NHS are taking effective action, adding the NHS is failing to identify potentially chargable patients and this is where GPs could play a role.

When treating patients with a European Health Insurance Card (EHIC) the report says that ‘needs arising’ treatment costs in primary care can be reclaimed if the EHIC is recorded.

The report says: ‘There is also scope for GPs to report European Economic Area patients through the EHIC scheme, which would allow the UK to recover costs from other EEA countries and thereby increase income for the health system.’

It recommends: ‘NHS England should clarify what it expects of GPs in relation to identifying chargeable overseas patients, and issue guidance by the end of June 2017. The guidance should set out the role of GPs in the charging system and how they might best fulfil this role.’

Though the DH is supportive of GPs doing this there is no system in place for this and the report states GPs are ‘not contractually obliged to do anything to identify overseas visitors.’

Meg Hillier MP, chair of the PAC, said today: ‘The Government’s failure to get a grip on recovering the costs of treating overseas visitors is depriving the NHS of vital funds.

“Our Committee has reported extensively on the financial pressures facing the health service and it is simply unacceptable that so much money owed should continue to go uncollected.'

But RCGP chair Dr Helen Stokes-Lampard said the report was ‘overstating’ the financial gains to be had from greater enforcement of overseas charging.

Dr Stokes-Lampard said: ‘It is the role of GPs and our teams to deliver care to our patients, free at the point of need, regardless of their individual circumstances. We must stop perpetuating this idea that general practice should, in whatever way, assist with border control.’

'The entire NHS is in a dire financial situation, but we shouldn’t exaggerate the amount of money that can be raised through GPs getting involved in cost recovery - particularly when balanced against the administrative and training costs that introducing such a process would incur.’

Readers' comments (22)

  • Aren't we always being told to act within our level of competencies? I don't recall having attended a module on debt-recovery whilst studying for my degree.Perhaps it's because I was a lazy git who just failed to attend that part of the course all those years ago. I must admit though, on a particularly bad day, I do harbour some pretty dark fantasies which do involve pliers, a car battery and the power which comes from denying someone their tramadol script.......

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  • Big way of solving this is a copayment system, EVERYONE pays then claims the cost off the government after the treatment event ala France,no need to report then.Who the hell do we phone to report this anyway is there a special department who will do this.Its not part of the contract so we will not do anyway.Lastly we can't charge foreign patient GPs have to treat them for free so why should we do something that does not really involve us.The claiming for healthcare tourist is a smoke screen anyway for chronic underfunding,denergation and destruction of the NHS by the NASTY PARTY.

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  • No. Sort this mess out yourselves.

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  • Easy, lets us charge overseas patients. As a small business we would ensure we were charging everyone possible : However the cardigans in their Ivory Towers seem to get very distressed by such evil ideas and will argue vehemently against.

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  • Surely if we treat someone who has an EHIC Card and then claim the cost of treatment the funds would go to the surgery providing the treatment, not the government?

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  • This comment has been removed by the moderator.

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  • And the NHS could do more to help GP practices stay financially afloat. Sort out the ridiculous way they pay practices where nothing is itemised and practices managers have to constantly contact NHSE to see what various monies are for.
    Surely the cost of treating patients from abroad in general practice is peanuts compared with secondary care costs?

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  • not in my contract to do this so no amount of guidance will make any difference. And should be charging over seas patients fee for service just like all other sensible healthcare systems

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  • Forgive me if this has been surpassed but as far as I'm aware it has not been. DoH's own standard operating procedure 2015 says;

    "Therefore all asylum seekers and refugees, overseas visitors, students, people on
    work visas and those who are homeless., overseas visitors, whether lawfully in the
    UK or not, are eligible to register with a GP practice even if those visitors are not
    eligible for secondary care (hospital care) services."

    I suggests MPs learn a little bit more about the guidance they are forcing us to adopt.

    https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/11/pat-reg-sop-pmc-gp.pdf

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  • Is it not a myth that we cannot charge foreign patients?
    We cannot charge them for immediately necessary treatment but it they are not entitled to register with an NHS GP then other contacts are chargeable and the money belongs to the practice.
    Have I missed something? Ignoring waffly 'recommendations' ridden with words like 'ideally', 'should', 'preferable', 'normally', etc can someone show I am wrong?
    I this were formalised then it would highlight who is not entitled to NHS treatment at GP level and increase the likelihood of any secondary care being chargeable.

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