GPs will be expected to issue private prescriptions and charge for other services they provide – such as diabetic clinics – if their patients are not eligible for free treatment, under the Government’s proposed scheme to recover more of the costs of NHS care from short-term migrants.
The proposals add detail to an announcement last week of a Government U-turn on previous proposals that GPs should charge non-EU migrants for all primary care ‘at the point of delivery’ unless they paid a new levy of between £200 and £500 per year.
The Government said last week that GP appointments will continue to be free to access for all temporary migrants to the UK, whether they paid the new levy or not.
But details in a response to a consultation on their plans published on the Department of Health website today reveal that anything other than a GP consultation may have to be paid for under the new scheme.
The document says: ‘Primary care outside of a GP consultation (or equivalent) will be chargeable. A final list of services included in this charging extension will be designed in conjunction with NHS colleagues. NHS care given in the community will be chargeable where charging is practicable and not detrimental to public health.’
It goes on to detail that it is looking at charging for use of walk-in centres, prescriptions and other services, such as diabetic clinics.
It says: ‘Primary care includes a broader range of treatment services, mainly but not solely triggered by GP consultation. These include community based services, dental and optical services. The weight of the argument for charging in these is much stronger, e.g. for drug prescribing where there is evidence of otherwise chargeable non-residents accessing NHS prescriptions at the subsidised fixed tariff or even free if, for example, they are exempt on the basis of age.’
The plans also detail plans to modify the way the NHS number is used on GP systems, although it stresses that it wants to introduce a scheme that is not ‘unduly burdensome’ on practices.
It proposes flagging the NHS number to indicate that a migrant has paid their surcharge and is eligible for free treatment, and charging all patients without a flag – or who do not have an NHS number yet – for all NHS care, apart from GP consultations.
The documents say that the DH will develop plans on how the registration process will be changed to ensure short-term migrants pay for NHS care, but that there was no clear consensus from their consultation on whether this should be done by GPs or not.
It says: ‘There was no firm consensus on whether this should be done through individual GP practices or through a more centralised system. There are advantages to both, but in either case we will ensure that GPs do not have to be directly involved in the process of identification and
establishing eligibility. We will explore and test options with stakeholders including costing proposals in time and money, and set out further plans in our full implementation plan in March 2014.’
Plans to charge migrants to see a GP had countered stinging critique from doctor leaders, including the BMA and the RCGP, which said they could lead to adverse effects on public health and cause GPs to become a ‘new border agency’.