Q. Is there a difference in the eligibility for treatment of certain overseas visitors – for example, people who have been granted asylum, those with a Visa, those from the EU?
Essentially, the different residence status of overseas visitors only becomes an issue when referring a patient to secondary care. According to guidance from the Department of Healths in England, Scotland and Wales, GPs can exercise their discretion to accept overseas visitors as fully registered NHS patients, or as temporary residents if they are only in the area for three months or less.1 There is no minimum period that a person needs to have been in the UK before a GP can register them.
Q. Should we be checking the identity and proof of residency of all new patients?
The English DH guidance points out that: “It is the relevant NHS body’s duty, not the GP’s, to establish entitlement for free hospital treatment. Furthermore, neither relevant NHS bodies nor anyone acting on their behalf, should imply that a particular patient should not be registered with a GP practice, as that is exclusively a matter for that GP.”
However, being registered with the practice, or having an NHS number, does not give a person automatic entitlement to access free NHS hospital treatment. With this in mind, if you feel it is necessary to refer a temporary patient for hospital treatment, you should make it clear in the referral letter that you believe the patient is visiting from overseas so that the overseas visitors manager at the relevant NHS body can check whether the patient is entitled to free NHS hospital care. (The DH guidance recommends you display posters in the practice explaining the restrictions on entitlement to free hospital treatment).
Q. Where GPs feel it to be appropriate, can practices recommend that migrants register with another practice (for instance, somewhere nearer to where they live, or a specialist centre such as a PMS/APMS practice set up for migrants)?
It is at your discretion whether to register any new patient. If you have a policy of not accepting patients who live outside a defined practice boundary, you will no doubt want to take that into consideration. However, any decision not to accept an application from an overseas visitor for inclusion on your list must be based on reasonable grounds, and must not be discriminatory.2
Q. If a patient has urgent health needs, can you treat them without registering them as a patient?
Yes, in fact you have a contractual duty to provide immediately necessary treatment as well as an ethical duty to treat in an emergency, regardless of whether the person is an overseas visitor or registered with the practice.
If treating an overseas visitor, you are unlikely to have access to the patient’s previous medical records so it is important to take a full medical history, including any underlying health conditions, allergies, medication regimes and dosages.
As with any consultation, it is important to make a clear and contemporaneous record of the discussion with the patient, whether they are fully or temporarily registered.
Q. How should you handle a consultation where you don’t have a common language with the patient, or access to a translator?
For patients who don’t speak English, it is obviously preferable to see them with an interpreter. Sometimes a family member can act as a translator, but this may not always be appropriate. Much will depend on the urgency of the consultation and it may be preferable to rearrange the consultation for a time when a translator can be found. If the consultation is urgent, you may have to do your best in the circumstances and ensure you keep a detailed record.
Dr Wendy Pugh is a GP and a medico-legal advisor with the Medical Defence Union.
1 For England: Department of Health. Guidance on Implementing the Overseas Visitors Hospital Charging Regulations and in Scotland website advice to Overseas Visitors.
For Scotland: The Scottish Government. Health services: overseas visitors. Last accessed 31 Jan 2012.
In Northern Ireland a consultation on this issue is in progress.
2 HM Government. NHS GMS contract 2004, paragraphs 15-17. 2004.