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BMA rejects plans to charge migrants for NHS care



Government plans to charge migrants a ‘levy’ for using the NHS are unworkable and would put more pressure on already overstretched GPs, the BMA has warned.

The representative body for doctors said that the system proposed by the Government was ‘impractical, inefficient, uneconomic and could cause unintended damage to NHS services’.

The claims came as part of the BMA’s official response to a consultation on the Government’s plans for non-resident migrants from outside the EU to either opt in and pay a new levy of between £200 and £500 per year upon entering the country, or pay for all primary care treatment up front.

The BMA said the proposals was unlikely to be cost-effective as a whole system would need to be set up to check the status of migrants, with GPs forced to determine if patients were permanent residents before they were able to treat them.

The response says: ‘It is difficult to see how extending charging to general practice could be implemented without ensuring every patient was checked by their GP practice when they register, resulting in inconvenience for all patients and an increased administrative burden on already over-stretched GP services.

‘There is no explanation of what documentation patients will need to use to prove they have permanent residency. There is no obligation for UK residents to hold a passport and the documentation some practices currently require, such as utility bills, would not prove permanent resident status.’

The submission follows a similar deconstruction of the plans from the Doctors of the World UK group, which said that a charging system would cost more to implement than the income it would bring in.

A BMA spokesperson said: ‘There is no evidence that the income derived from charging short term visitors or migrants would be sufficient to cover the significant cost of the increased bureaucracy necessary to administer the system.’

They added that forcing non-European Economic Area migrants to pay for healthcare could deter skilled migrants from coming to work in the UK, and could deter them from seeking emergency care, or bring their children to a GP practice.

If migrants are deterred from seeing a GP, it may become more difficult to identify infectious diseases like TB, increasing the public health risks for the wider population and placing further stress on NHS services, they said.

BMA Council chair Dr Mark Porter said the NHS needs to spend money on patient care rather than asking GPs to carry out administrative tasks.

He said: ‘The NHS does not have the infrastructure or resources to administrate a charging system that is not likely to produce enough revenue to cover the cost of setting up its own bureaucracy. The NHS does not need more administrators; it should be spending its money on caring for patients.’

He added the proposals could have economic consequences: ‘More worryingly, the proposals could have an impact on the care all patients receive. If non-EEA doctors are forced to make contributions to their healthcare this could discourage them from coming to practice in the UK and working in key services, such as emergency departments, which are experiencing doctor shortages. This could exacerbate the current workload pressures already facing the NHS.

‘The Government needs to rethink it is entire approach to this issue as in their current form these proposals are unworkable and potentially damaging to the NHS.’

The news comes after a Pulse survey found that more than half of GPs agreed that entitlements for migrants are too generous.

GPC chair Dr Chaand Nagpaul added that GPs do not have the resources to implement a bureaucratic system whose worth to the taxpayer is unproven.

He added: ‘We have seen with the recent NHS 111 debacle what happens when an ill-thought out policy is rushed through without proper consideration of the practical and clinical implications. Ministers need to learn from recent experiences and work with healthcare professionals to find workable solutions to this issue.’

Dr Una Duffy, chair of Bedfordshire and Hertfordshire LMC said she did not support a levy for migrants, but said the system needed to be reformed as currently GPs were acting as immigration police.

She said: ‘In some areas of Bedfordshire and Hertfordshire GPs were feeling that their staff spent inordinate amounts of time as border control, working out who would be temporary, who was an NHS patient and so on. These small numbers of patients can cause masses of work for practices, on the administrative side.’

[Bedfordshire and Hertfordshire LMC’s chief executive] Dr Peter Graves the issue raised in Parliament, asking could we not have a simple system where there’s a card, so practices know straight away whether a patient can be registered. We didn’t ask for fees, for people to pay money when they enter the UK. I understand why the BMA have rejected this because it’s going to be incredibly difficult to administer. It will add another job. It’s not the right system, but there does need to be a change so that GP practices are not acting as the immigration police.’