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GPs should never be asked to determine a patient’s immigration status before treating them

Dr Angela Burnett writes about the latest NHS charging policy affecting torture survivors

Freedom from Torture, working with a coalition of other organisations, has recently won concessions for refused asylum seekers and other vulnerable migrants who would otherwise have been targeted by the Government’s crackdown on so-called health tourism.

Since April, overseas visitors to the UK who do not possess an European Health Insurance Card (EHIC) can be charged 150% of the tariff for secondary health care. This was meant to have included torture survivors with a refused asylum claim. However it has now been announced that torture survivors and survivors of human rights violations such as female genital mutilation will be exempt from the charges - provided the secondary care they need relates specifically to injuries from the violations they have suffered.

Torture survivors who had live asylum claims were previously exempt from secondary charging. The new announcement means that torture survivors who are refused asylum can also seek NHS care for their trauma and related injuries without fear of being billed; and GPs can advise secondary care providers to treat this group.

As I and other health professionals at Freedom from Torture work with a number of torture survivors who are refused asylum, this announcement offers some comfort to our client group.

However it still leaves me as a doctor with the conundrum that torture survivors who are refused asylum, or who do not have a live asylum claim, may still be charged for care for conditions which may be held not to relate to their torture, for example a chronic condition such as diabetes.

As a health professional working holistically for the rehabilitation of torture survivors this does not make sense to me. All aspects of physical and mental health will contribute to an individual’s recovery from torture.

The Government has said the intention of this secondary care charging policy is to discourage ‘health tourism’ and claw back £500m a year by charging migrants, visitors and former UK residents for using the UK’s health services.

However the reality is that those who are hit hardest - such as refused asylum seekers who are often survivors of human rights violations and often destitute - cannot be described at all as health tourists, and the secondary care charging policy has serious consequences for them.

Women who do not see a doctor until late in pregnancy are at a much higher risk of complications but many of the mothers-to-be recently surveyed by Doctors of the World had not sought medical advice until this time, often because of fear of charges or of the NHS challenging their immigration status.

Charging for primary care has also been mooted, and should be addressed now by the Department of Health now the election is over.

As a practising GP, as well as lead doctor for Freedom from Torture, I feel very strongly that it should not be my duty, or that of my colleagues, to determine my patient’s immigration status before considering whether I can recommend them for secondary care or treat them within the primary setting. My first duty is to give care.

It may increase the costs for both patient and the NHS alike if health problems worsen as a result of denial of treatment, which is the opposite of what the NHS should be doing if we need to save money.

Dr Angela Burnett is lead doctor for Freedom from Torture and a GP in Hackney.

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Readers' comments (9)

  • I couldn't agree more such a denial would strike at the very core of our professional ethos and would also detract from the fundamental tenet of our NHS. This is yet more cynical political pandering to the meanest sentiments of our population, stoking up the fear, hate and resentment of the foreign 'other'. This pseudo-economic 'straw man' proposition is supposed to make the government appear tough, but merely serves further to underline their essential moral bankruptcy.

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  • If the £22 billion is not saved, or being saved, then something will have to give. Nurses? Doctors? Hospitals? Drugs? Socialised healthcare itself? Or dare I say 'free' care for those who happen to have gained access to the UK mainland (as apprised to those who haven't had this opportunity who we feel very able to ignore.)

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  • The day we start trying to financially cripple the most vulnerable sections of our society is a sad day for the NHS. In terms of population size, we're only the 14th likely to accept asylum seekers in the EU - this hardly seems like a cost saving priority.

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  • So we're not supposed to act as border agency staff, but still expected to make endless secondary care referrals and write endless medical reports to assist asylum seekers in fighting their case to stay in the country? That's kind of having your cake and eating it? and this is after having worked in an inner city practice with a high level of asylum seekers... Vast majority of whom have the "entitled demander" complex

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  • National not International is our Health Service.

    We as a nation are not responsible for the whole world.

    Stop sending aid to foreign countries and divert that funding to NHS, we cannot afford both.

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  • @Anonymous | NHS Manager | 18 May 2015 9:18am

    That aid sent abroad is essentially a bribe to secure contracts.

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  • Absolutely agree with the "entitled demander" comment as above. We are also an inner city practice with high demand.
    People who have worked and paid taxes all their life are repeatedly let down by an NHS that cannot cope yet those who have never contributed and likely never will are entitled to everything.

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  • The fact that GPs are being asked to do this reflects failure of leadership on part of the GPC.The BMA of course being a strong marxist-leninist organisation came all out in favour of uncontrolled immigration.

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  • NHS GPs are under a contract to carry out medical duties as determined by the government of the day. If the author feels a moral obligation to provide services outwith that contract, she is at liberty to do so outside of her contracted hours.

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