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What do you think of charging migrants for primary care?

Letter from Dr Hannah Fox, London

As a volunteer GP at Doctors of the World’s drop-in clinic in Bethnal Green, I help excluded migrants and refused asylum seekers who are struggling to access NHS services that they are fully entitled to. They face barriers to care such as being asked for proof of address and ID that they simply do not have. Many are suffering from trauma caused by trafficking, conflict, torture or persecution. The vast majority have been living here for many years and only come to us because they are desperate.

The UK Government is considering making it even more difficult for these patients by charging them for primary care services, as well as A&E and ambulance services. Migrants and overseas visitors are currently charged for secondary care services at 150% tariff. I fear charging for primary care will have a detrimental impact on vulnerable patients.

I am reminded of an Afghan couple I saw a few months ago. In their late 60s, their asylum application had been refused and they were homeless and relying on the support of religious organisations for shelter. The wife struggled to care for her husband who had had brain surgery to remove a tumour, and carried his medication around with him in a dirty carrier bag. They had already been turned away from several GP surgeries. The introduction of charges would make accessing healthcare impossible for this couple.

As a GP in a busy practice, I am also concerned about the additional burden charging would place on practices. There is no suggestion that GP practices will get to keep the revenue recovered, yet receptionists will have to identify chargeable patients by asking immigration-related questions and raise invoices. I am sceptical that this scheme will manage to recover the amount of money it intends to for the NHS. Experience tells me this patient group will not be able to pay so will avoid GP practices instead. 90% of the patients at Doctors of the World’s drop-in clinic live below the poverty line.

Charging poor and vulnerable patients also raises medical ethics issues. GPs will have to make clinical decisions based on a patient’s ability to pay. As a doctor I have a duty to provide appropriate medical care to all people without discrimination. What do I do when my patient is too poor to pay for diabetes care?

Doctors of the World and the RCGP Junior International Committee are keen to hear your views on charging migrants and overseas visitors for Primary Care. Please take a few minutes to complete this survey

If you would like to write to Pulse, please email

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Readers' comments (7)

  • National Hopeless Service

    It would be far better if some of the foreign aid money was diverted into paying for such care.

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  • CoPayment system will sort this out .

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  • When charging between Health Boards was introduced (20+ years ago), it required several extra staff to be employed even in our small board, just to process the claims. No cash changed hands, so we didn't need cashiers, safes, EFPOST machines, auditors, or any method of checking eligibility. You'll need all of this in every surgery! Quite apart from the inequity, general xenophobia, stupidity, etc. of this proposal, it will cost so much that there will be no gain for the NHS. It's only a political stunt for favourable publicity amongst the UKIP tendency of the Tory party. Any participation merely supports their cause.

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  • "GPs will have to make clinical decisions based on patents ability to pay"
    Yes, we will. There is nothing wrong with this and many far more advanced healthcare systems operate on this basis. Just as our decisions are influenced by the country's ability to pay by NICE and many CCGs dictate so we can accept patients views on how much they are prepared to contribute to their medical needs.

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  • AlanAlmond

    Moral high ground is always a comfy place to pitch ones tent. So much easier than having to deal with almost impossible decisions about how to allocate limited resources. Of cause people in crisis deserve our help. The county's health service is collapsing for lack of investment. How do you square this circle? One thing is for sure ignoring the issue won't make it go away.

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  • we should be charging everyone, not just migrants

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  • It is quite wrong that the taxpayers of the UK have to fork out for the care of those coming from abroad, particularly when it is acknowledged on all sides that there is simply not enough money to support the existing NHS. OK, so this amount is a relatively small proportion of the total NHS budget, but it equates to millions of pounds - and if you don't want it for your area, then I will happily agree to receive it on behalf of my own CCG or local hospital. It would fund a lot of clinics and operations for those in the UK who are currently going without the healthcare they have been promised at the time when they need it.
    Whether GPs should have anything to do with collecting this money is an entirely different question.

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