Posted by: Editor's Blog1 July 2013
There was plenty of coverage in the national press over the weekend of Jeremy Hunt’s forthcoming announcement over migrants access to the NHS – and not for the first time.
In fact, getting tough on immigrants abusing the NHS’ popularity is such an apparent no-brainer vote-winner that it seems to have been trailed on an almost weekly basis this year. In the Daily Mail alone we had immigration minister Mark Harper talking tough to Romanians and Bulgarians in January, David Cameron insisting those from outside the EU should pay for using British hospitals in February, then the suggestion British patients could have to carry an NHS ‘entitlement card’ in March, followed by home secretary Theresa May and the Prime Minister once again weighing in. Clearly it’s a policy far too popular to only have been announced once.
But while the review has been in the pipeline for months, if not years, it seems it is now finally here and will be trailed no more – Mr Hunt is scheduled to reveal details of his plans in the House of Commons on Wednesday.
His announcement is likely to divide the profession.
Many GPs have an instinctive reluctance to get involved in checking patients’ entitlement to care. As GPC deputy chair Dr Richard Vautrey puts it: ‘Doctors are many things. They must not become immigration officers and border guards.’ Others feel that denying care to a patient in need, regardless of their nationality, is not what they went into medicine for in the first place.
But equally many grassroots GPs have frontline experience of some patients who should not be entitled to care taking advantage, and would like to see the rules tightened up. In fact, these GPs are in the majority. A Pulse survey in January found that 52% of GPs believe NHS provision for migrants is too generous, and only 7% believe it is not generous enough. As Dr Paul Roblin, chair of Berkshire, Buckinghamshire and Oxfordshire LMC told Pulse then: ‘GPs are expected to practise with limited healthcare funding and if we are using that money for treating visitors, the taxpayer loses out.’
One thing nearly everyone is agreed on though, is that whatever the rules are, they need to be published and made clear.
Currently the rules around migrants’ access to both primary and secondary care are a minefield, with extensive and often contradictory guidance unequally applied.
According to NHS Primary Care Commissioning guidance for instance, ‘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 services’. GPs are allowed if they wish to ask patients to prove their immigration status – although there is no formal requirement for them to do so – but if they do, they must ask every patient.
Some patients may be entitled to free primary but not secondary care, leading to tricky questions over what to do with patients who badly need essential yet non-urgent hospital treatment. Are GPs responsible for treating patients beyond their remit?
And while asylum seekers and refugees are entitled to register with GPs, there’s a grey area over failed asylum seekers. Many CCGs advise that GP practices ‘have the discretion to accept failed asylum seekers’, although the BMA advises this discretion applies only in as much as it would for any other patient.
Confused? You should be. And as Pulse’s survey earlier this year found, most GPs are. Three quarters of survey respondents said they were frustrated by the lack of clarity around NHS entitlements and many practices seemed to be operating contrary to official NHS guidance – 38% of GPs, for instance, said they would not register a person they believed to be an illegal immigrant.
Even worse, in the general confusion, GPs seem to get it in the neck from both sides. A practice in Essex was forced to re-register a family of migrants known to be without permission to stay in the UK because of the threat of legal action; meanwhile one in ten primary care organisations investigated GPs thought to be treating undocumented migrants even though DH guidance said they should not have.
It was, perhaps, the first commenter on our story this morning who put it most succinctly, in the unmistakeably authentic voice of the long-suffering GP: ‘Well, can we have some actual guidance not the wishy washy rubbish of previous years.’
The tricky decision of who should have access to NHS care is a complex moral and economic one, and one which is rightly down to the politicians. Now that they’ve made it, for better or worse, it must be communicated clearly and applied consistently to end the current confusion.
Steve Nowottny is the editor of Pulse. You can follow him on Twitter @stevenowottny.