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Independents' Day

DH considering where to 'draw the line' on charging overseas patients for GP services

Exclusive The Government is looking at ‘where it would draw the line’ on charging non-UK residents for using general practice, the Department of Health’s lead on the issue has said.

Speaking at a Pulse Live event in London yesterday (Tuesday), the DH’s patient cost recovery programme lead Kate Dixon told delegates the department was looking at what was ‘fair’ to charge for, suggesting that long-term drug prescriptions could be charged, while diagnosis by a GP would remain free.

The DH is set to roll out pilots, exclusively revealed in Pulse, for GPs’ to check patients’ European Health Insurance Cards to prove their eligibility for free secondary care, and Ms Dixon said the DH is looking at how practices could be fairly remunerated for the extra time spent recovering costs above and beyond the administration fees they will be paid as part of the pilots.

The Government has previously claimed that ‘health tourism’ is costing the NHS around £200m a year.

Pulse revealed earlier this year that the DH was looking at how to retrieve the costs of international visitors using GP services, but it said that any plans to charge non-UK resident patients would ‘require further consultation’.

However, Ms Dixon yesterday indicated that the Government is considering charging for certain GP services.

When asked by Pulse whether the DH would charge in future for GP services, Ms Dixon replied: ‘I think we haven’t worked it out, but… there’s probably significant cost areas that are a gateway through GP practices.

‘For example, is it right if a wealthy student comes and tops up all their drugs while they’re here for university, or someone who’s from outside the EEA comes and pulls out a whole list of prescriptions, and the NHS covers that? That doesn’t seem fair.

‘But actually, a diagnosis to find out what’s wrong with someone probably does seem fair.’

Ms Dixon explained urgent and emergency care would always be free at the point of use, as would services important to public health, such as an appointment to check for infectious disease.

On the issue of GP administration costs, Ms Dixon said that the DH was ‘using the EHIC scheme… to work out what is that actually worth.’

The chair of the session, Dr Fiona Cornish, a GP in Cambridge, pointed out that hospitals get to keep 25% of costs they recover from overseas visitors.

Ms Dixon said: ‘We’re paying the 10 pilot sites admin costs, to work out the process and work with us on some materials. It would be a question for NHS England about how we want to roll that out, but we are thinking about it.’

This is the latest development in the issue of charging non-UK resident patients.

The Government had proposed in 2013 to bring in an NHS ‘levy’ for overseas visitors to cover their health costs, but dropped these plans early last year.

However, legislation introduced in the Immigration Act  2014 redefined eligibility for free healthcare, which is now only available to UK residents with ‘indefinite leave to remain’.

This change enabled the Government to again explore the possibility of charges to cover the costs of overseas visitors accessing primary care.

Ms Dixon added that the Government was also reviewing legislation that allows British expats to claim residency in two countries, spending enough time in the UK to maintain access to the health service.

She told delegates: ‘We’re starting a piece of work to tighten the definition of ordinary residency, for EEA patients.

‘Because it is the case at the moment, as you say, you can be classified as an ordinary resident in two different places, so we’re looking at that. It will require some legislation change, but we think it is an important piece of work to do.’

Pulse surveys have found that as many as three quarters of GPs do support charging overseas visitors upfront for accessing primary care, though GP leaders have labelled the plans ‘regressive’.



Related images

  • Patient registering registration boundaries practice  PPL

Readers' comments (9)

  • Charge all as private patients if they cannot produce proof of UK residency or a European Health Card. Most of us take out travel insurance when going abroad and UK visitors need to do the same when visiting here.

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  • Agree wholeheartedly with previous comment -
    However as independent contractors to NHS why should GP time be free - especially when enormous demand from registered patients

    I am afraid they can to to drop in centres or A and E

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  • We get ordinary residents living in Spain who come to UK to get their prescriptions and ask for 6 months prescriptions to be issued and they go back to some fancy Island.
    We get visitors coming to OOH to get their prescriptions issued in EU. Patients will always find a way around. The system is so open to abuse, unbelievable. From a doctor's point of view, I feel why should I deprive my patients of expensive medications and sophisticated stoma devices when NHS spends so much money on health tourism?

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  • TBH I presumed that a foreign visitor would alwys have been charged for a consultation. We definitely did when I worked in a walk in centre 5 years ago. £75 is going rate for 15 mins. I dont even understand this debate and even less why theyre now saying it should be free to see a doc? I suggest if non-NHS youre free to do what you want as its is automaticcally private work and you can either charge or do it for free. I would charge.

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  • I agree with the first comment - they have paid nothing into our system - so why should they get it our specialised services free

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  • David Michael Andrews

    once again the dept health show crass stupidity anyone who goes abroad from uk has to have insurance or EHIC they also have insurance as visitor to this country should the NHS is incompetent loosing millions that could provide a better service for uk look at spain and othe countries to see what they do there is nothing to think about excepot charging overseas visitors no wonder we get nhs holiday visitors drain the resources of the nhs and piss off home no cost except to us this must be stopped we have never had such an incompetent bunch of morons managig the always chat about charging at home start with people coming in for free treatment .we also need to review the nhs management ans slash to acceptable levels and what power the ccg have and review its remit in favour of nhs not incompetent people sitting around a table making out of touch uninformed decisions even though supposed to be Gp's on the board but a bit of power changes the mindset money after money will not work until we have a competent government,department of health ccg,NHS England and all the other money draining ineffective quango's throwing money into a bottomless pit without policies,procedures and total review will do nothing it is a false economy from a government in a total mess due to bottle it cameron and his brain dead ministers running on greed

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  • Secure environments GP

    I think this response I had to an email from Dept of Health should be public domain.

    > Dear Sir/Madam
    > Regarding your publication on 15th February 2015 on page link
    > The statement "Treatment in A&E departments and at GP surgeries will remain free for all." is incorrect and misleading.
    > As a GP I can comment that, we are only obliged to treat EU residents for free. We are under no obligation to treat "for free" residents of other countries e.g USA. We are permitted to charge a private fee which the patient may be able to reclaim from their insurer.
    > This statement is misleading and likely to swamp general practices with inappropriate workloads.
    > Please ensure a correction ASAP.
    > Yours sincerely

    A common misunderstaning of mine I would assume then.
    When I rang the DH the chap on the end of the line insisted we should provide free treatment for any and all visitors regardless of country of origin.

    We are not an emergency service like A&E and I thought they appear to be mixing up hospital and GP services. He said I should send an email to the address he gave, so I did and have asked the GPC to look into it.

    Our ref: DE00000921350

    Dear Dr Barrett,

    Thank you for your email of 18 February about visitors’ access to primary care services.

    I note your concerns that information published by the Government is incorrect.

    However, primary care services, including GP and nurse consultations, are currently free to all who require them. No patient should be refused or charged for NHS primary medical care services on the basis of their nationality or immigration status. The Government’s position is that people should continue to have unrestricted access to early diagnosis and intervention in the health interests of both the public and the individual.

    As set out in the National Health Service (General Medical Services Contracts) Regulations 2004 (as amended), under the terms of their primary medical services contracts, GPs have a measure of discretion in accepting applications to join their lists of NHS patients as a permanent or a temporary resident (a GP practice may accept a patient as a temporary resident if they are in the practice area for more than 24 hours and less than 3 months).

    GP practices cannot refuse an application to join its list of NHS patients on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition. They can only turn down an application if NHS England has agreed that they can close their list to new patients or if they have other reasonable grounds.

    In practice, this means that the GP’s discretion to refuse a patient is limited. Examples of where a GP may refuse to register a patient would be if the patient was abusive or if there was a good clinical reason, such as the GP believing that the patient would be better served if registered at a different practice. A person’s nationality or immigration status are not considered reasonable grounds to refuse to register them as an NHS patient.

    Within the Visitor and Migrant NHS Cost-Recovery programme, the Department will consider amending and extending the current charging regulations as they apply to overseas visitors and migrants. This will include considering introducing charging for primary medical services as well as other primary care services such as pharmacy, optics and dentistry.

    Whilst I appreciate that this may be a disappointing reply, I hope it clarifies the Government’s position on this matter.

    Yours sincerely,

    Ryan Diggory
    Ministerial Correspondence and Public Enquiries
    Department of Health

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  • Just charge everyone.

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  • I would ask that the 'Editor' now looks at my email of the 28th. Of February 2015! This was my experience.

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