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Independents' Day

Many grassroots GPs may back the Government's migrant levy - but they won't if they have to police it

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It’s not often you find grassroots GPs siding with Jeremy Hunt over the BMA and RCGP.

But charging migrants to use the NHS is one issue where GP representatives appear to be out of step with the majority of those they represent.

After a raft of national newspaper headlines yesterday about the costs of ‘health tourism’ - based on an independent report commissioned by the Department of Health - RCGP chair Professor Clare Gerada was quick to attack the Government’s plans to clamp down on foreigners using the NHS as ‘xenophobic’.

The BMA too has been fiercely critical of the scheme. ‘Impractical, inefficient, uneconomic and could cause unintended damage to NHS services’ was their damning verdict.

And the small but vocal group of GPs on Twitter yesterday were for the most part equally scathing. ‘Plans to recover NHS costs from immigrants are an excuse to set up the bureaucracy necessary to charge the rest of us,’ was how Hackney GP Dr Jonathon Tomlinson put it. ‘Wake up everybody.’

And yet, Pulse’s poll finding today that GPs in fact support the Government’s plans for a levy on migrants by a margin of almost two-to-one should come as little surprise.

It has long been apparent that many GPs - perhaps less vocal, possibly less urban - have grave concerns about the rules around migrant access to the NHS.

In January, Bedfordshire and Hertfordshire LMC wrote to the Department of Health and the Home Office warning about the ‘abuse of the NHS’ by overseas visitors and suggesting that so-called health tourism was a ‘national issue’. In the same month, a Pulse survey found that more than half of GPs believe that NHS entitlements are too generous.

So, is charging migrants for care that rarest of things: a radical Department of Health policy the profession can unite behind? Well, no - and for two reasons.

Firstly a significant minority - 30% of GPs, according to our poll today - are opposed to the plans, many of them vehemently. BMA deputy chair Dr Kailash Chand has written for Pulse arguing passionately against the migrant levy and its likely effect on patient care, citing his own experience as an immigrant from the Punjab. Many share his concerns.

But secondly, and more signficantly, there are the details of the policy itself. Among the respondents to Pulse’s survey who said they supported the Government’s plans, there was one common theme in their comments: just don’t make us police it.

Here the BMA, RCGP and grassroots GPs are singing from the same hymn sheet. ‘As long as the area team administers it,’ was one GP’s caveat. ‘As long as it is centrally collected and not dumped on GP practices to add unpaid tax collecting to their role,’ said another.

For his part, Jeremy Hunt insists GPs will not be forced to act as ‘border guards’. But he acknowledges there is ‘always a small amount of administration involved in GP or NHS registration’, and the fear is that even if GPs are not responsible for collecting the levy itself, the process of checking that new patients are entitled to care could add a substantial administative burden.

For now, ministers may be pleasantly surprised to discover they have many GPs’ support in principle. Exactly how the system is implemented as practices grapple with an ever-increasing workload will be crucial if they wish to keep it.

Steve Nowottny is the editor of Pulse. You can follow him on Twitter @stevenowottny.

Readers' comments (8)

  • I blogged about this recently:

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  • We already have to police this and try to figure it out- its just at the moment there is no clear guidance, and when you ask someone the answer is almost universally 'you don't have to, but if you don't the risk is on you.'

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  • Do GPs understand that they may be at the receiving end of litigation for racial discrimination if they, or their staff, get this wrong? The official guidance now runs to 87 pages. This initiative is unlikely to make things similar. They may need to retain an immigration consultant to help with difficult cases.

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  • This is the 21st Century. Its cheaper for me to attend medical conferences abroad as the flights and hotels are cheaper than UK trains and hotels. While I am abroad I access cheaper dental care. So it is the same for overseas visitors, who travel cheaply from any where in the world to access free health care, this is unsustainable.

    The registration process in primary care is not fit for purpose. Its possible to register as any name and any sex !, just ask your clerical staff.

    ID cards will have to be introduced with NHS numbers on, and a central database provided that surgeries and hospitals can contact to confirm a patients entitlement - the same process for all - so no discrimination.

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  • Until the NHS number is linked to immigration status and there access to health care needing to be presented prior to care being given this is a non starter. This is the situation in BC Canada. The health card is linked to your Visa status. Without your card you have to pay.......

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  • Can anybody really believe that HM Government is capable of introducing a system that would charge overseas visitors and illegal immigrants for primary care services? Not a chance. Every other country has managed it, it seems, but no way in the UK! It would require statesmen, and all we've got are politicians.It's another red herring, a soundbite from a Secretary of State intended to impress voters that Something Is Being Done under his watch. Ignore it, it'll go away.

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  • Britain has long opened it's doors as a bribe to allow it to sell it's goods and services elsewhere.Its the EU,China and India which dictate our immigration policy.As always its the money men who benefit while the taxpayer forks out the bill.

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  • I insure myself when I go abroad. Why not the same for people who come here? What is the difficulty?

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