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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’.