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BMA rejects plans to charge migrants for NHS care

Government plans to charge migrants a ‘levy’ for using the NHS are unworkable and would put more pressure on already overstretched GPs, the BMA has warned.

The representative body for doctors said that the system proposed by the Government was ‘impractical, inefficient, uneconomic and could cause unintended damage to NHS services’.

The claims came as part of the BMA’s official response to a consultation on the Government’s plans for non-resident migrants from outside the EU to either opt in and pay a new levy of between £200 and £500 per year upon entering the country, or pay for all primary care treatment up front.

The BMA said the proposals was unlikely to be cost-effective as a whole system would need to be set up to check the status of migrants, with GPs forced to determine if patients were permanent residents before they were able to treat them.

The response says: ‘It is difficult to see how extending charging to general practice could be implemented without ensuring every patient was checked by their GP practice when they register, resulting in inconvenience for all patients and an increased administrative burden on already over-stretched GP services.

‘There is no explanation of what documentation patients will need to use to prove they have permanent residency. There is no obligation for UK residents to hold a passport and the documentation some practices currently require, such as utility bills, would not prove permanent resident status.’

The submission follows a similar deconstruction of the plans from the Doctors of the World UK group, which said that a charging system would cost more to implement than the income it would bring in.

A BMA spokesperson said: ‘There is no evidence that the income derived from charging short term visitors or migrants would be sufficient to cover the significant cost of the increased bureaucracy necessary to administer the system.’

They added that forcing non-European Economic Area migrants to pay for healthcare could deter skilled migrants from coming to work in the UK, and could deter them from seeking emergency care, or bring their children to a GP practice.

If migrants are deterred from seeing a GP, it may become more difficult to identify infectious diseases like TB, increasing the public health risks for the wider population and placing further stress on NHS services, they said.

BMA Council chair Dr Mark Porter said the NHS needs to spend money on patient care rather than asking GPs to carry out administrative tasks.

He said: ‘The NHS does not have the infrastructure or resources to administrate a charging system that is not likely to produce enough revenue to cover the cost of setting up its own bureaucracy. The NHS does not need more administrators; it should be spending its money on caring for patients.’

He added the proposals could have economic consequences: ‘More worryingly, the proposals could have an impact on the care all patients receive. If non-EEA doctors are forced to make contributions to their healthcare this could discourage them from coming to practice in the UK and working in key services, such as emergency departments, which are experiencing doctor shortages. This could exacerbate the current workload pressures already facing the NHS.

‘The Government needs to rethink it is entire approach to this issue as in their current form these proposals are unworkable and potentially damaging to the NHS.’

The news comes after a Pulse survey found that more than half of GPs agreed that entitlements for migrants are too generous.

GPC chair Dr Chaand Nagpaul added that GPs do not have the resources to implement a bureaucratic system whose worth to the taxpayer is unproven.

He added: ‘We have seen with the recent NHS 111 debacle what happens when an ill-thought out policy is rushed through without proper consideration of the practical and clinical implications. Ministers need to learn from recent experiences and work with healthcare professionals to find workable solutions to this issue.’

Dr Una Duffy, chair of Bedfordshire and Hertfordshire LMC said she did not support a levy for migrants, but said the system needed to be reformed as currently GPs were acting as immigration police.

She said: ‘In some areas of Bedfordshire and Hertfordshire GPs were feeling that their staff spent inordinate amounts of time as border control, working out who would be temporary, who was an NHS patient and so on. These small numbers of patients can cause masses of work for practices, on the administrative side.’

[Bedfordshire and Hertfordshire LMC’s chief executive] Dr Peter Graves the issue raised in Parliament, asking could we not have a simple system where there’s a card, so practices know straight away whether a patient can be registered. We didn’t ask for fees, for people to pay money when they enter the UK. I understand why the BMA have rejected this because it’s going to be incredibly difficult to administer. It will add another job. It’s not the right system, but there does need to be a change so that GP practices are not acting as the immigration police.’

Readers' comments (11)

  • When NHS money is stretched, we should in primary care be willing to ensure that only those entitled to care free should get it - when we go to other european countries we often have to pay and sort it out when we get home - If we carry on treating the world our health service will run out of money for our most vulndrable like the elderly etc

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  • Vinci Ho

    This is poison with sugar wrapping from the government . It doesn't really want to involve with the administration and policing . 'Leave it to 'people' and you can charge a fee , mate . Money can solve all problems'
    This is 'Big Society' theory after all......

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  • It is simple: if you have British Passport and current utility bill, or permanent residency stamp and utility bill no charge. EHIC (EHIC rarely accepted when I have needed to use) prefer charge and then pt recoups from their EU country. Rest charge

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  • Surprise! Err no!

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  • Dear Anon at 9.46 am
    There is no compulsion for British subjects to have a British passport. Many elderly patients and some young patients have never had a passport although they/their ancestors have been living in UK since the Anglo-saxon invasion. Also presently many people are on different work VISAs but not permanent residents. Unless there is a specific law passed against same they are eligible for NHS treatment as they pay NI currently. Also if a law is passed it would not affect those already here as it would be likely to be against common principles and human rights law.
    Utility bills can be in any name given to the Utility company-e.g. student accommodations can have several name in each each utility bill. many are immigrant students.
    Last of all if anybody doesnt have the above but is in a medical emergency -do you turn them away as there is no legal requirement of now to have a valid identity document in UK.
    Also failed asylum seekers have sued some practices (with money from legal aid) for not registering them!
    Also voters list is of little use as 1 million commonwealth citizens presently in UK are eligible to vote in elections. (theoretically 2.245 billion people in the world can vote in U.K elections if they are in UK at the time of election and have registered with the council-i.e. entire common wealth population)
    Do you now see how complex this gets for each surgery to be checking?
    The government could pass a law for all people living in Uk to have an identity card which should state their entitlement but this has been rejected by the majority. Govt can charge an NHS insurance charge when anyone applies for VISA to enter Uk, but this will not cover existing migrants and also any future illegal migrants.

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  • >When NHS money is stretched, we should in primary care be willing to ensure that only those entitled to care free should get it
    --

    You might want to do this but I didn't sign up to have to police a broken immigration (or benefits) system. This should be for someone else to determine, so that I can stick to delivering healthcare.

    By the way, apparently NHS money isn't short since a 2bn surplus has just been returned to the government.

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  • Question to my GP colleagues:

    Do we have to take on failed asylum seekers and if so are they entitled to free NHS prescriptions and investigations?

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  • Yes and No – Key points are:

    • All asylum seekers and refugees are entitled to register with a GP and to receive free NHS
    hospital treatment.
    • GP practices retain the discretion to register refused asylum seekers to the same extent that
    they have this discretion in relation to registering any patient, regardless of his or her
    residency status.
    • Treatment of certain specified communicable diseases (for example tuberculosis (TB),
    Hepatitis B and measles), compulsory mental health treatment and treatment provided in an
    accident and emergency department are exempt from charges for all patients.
    • Health professionals must not discriminate against asylum seekers or refused asylum seekers
    by unfairly prioritising other patients in preference to them.
    • In England, refused asylum seekers and asylum seekers who are not receiving benefits may
    still be entitled to free prescriptions. Prescription charges have been abolished in Wales,
    Scotland and Northern Ireland.
    • Different entitlements to free hospital treatment for refused asylum seekers exist in each of
    the UK nations.
    • It is not the responsibility of doctors to make decisions on the eligibility of patients
    for free NHS hospital care.
    • Refused asylum seekers who were undergoing a course of hospital treatment at the time
    their claim for asylum was rejected are entitled to receive that period of treatment free of
    charge until completion.
    • Asylum seekers and refused asylum seekers have the same rights to medical confidentiality
    as other patients.

    For more exciting reading, see - Access to health care for asylum seekers and refused asylum seekers – guidance for doctors, November 2012

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  • @Anonymous | 28 August 2013 2:43pm
    Thanks very much for sharing that

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  • They won't be charged for care - but our sick and disabled, who paid into the system, are being charged for any letters (if they can actually get them) provided to prove to DWP/ATOS that they are, in fact, sick! Other countries insist on payment - in Florida, despite having adequate travel insurance, GP would not see foreign nationals without cash being paid up front - no credit/debit card payments or insurance accepted!

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