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GPs must provide routine care to tourists, says new BMA guidance

Exclusive GP practices should provide routine care to any patient – including tourists – even if they are unable to show proof of address or ID, new BMA guidance has said.  

The BMA clarified the guidance after acknowledging that there was confusion among GPs about which patients they should register and who could be privately charged, with variations in approaches across the country.

The new guidance – which the GPC says will be endorsed by NHS England – makes clear that even tourists who are staying in the area temporarily should not be charged either for emergency or routine care.

However, the clarification comes as the Department of Health is preparing to launch a consultation on extending charging for NHS services from overseas patients in general, which could include them being charged for accessing GP services.

The new BMA guidance says: ’There is no contractual duty to seek evidence of identity or immigration status or proof of address. Therefore practices should not refuse registration on the grounds that a patient is unable to produce such evidence.

’Anyone who is in England is entitled to receive NHS primary medical services at a GP practice and applications for registration for any patient in England must be considered in exactly the same way, regardless of country of residence.’

GPC deputy chair Dr Richard Vautrey said that the guidance means GP practices ’do have to treat tourists seeking general practice care if they are in their area and they have an open list’.

When asked whether this included routine care, he added: ’Yes, they’d just need to show that they were in the practice area.’

He said: ’It does not matter what you live in, or with whom, as long as the patient says they live within the practice boundary then the practice should see them under the current registration arrangements: immediately necessary care for those in the area that day; temporary residents if staying for up to three months; or full registration if beyond that.’

But he said this would not amount to practices working for free, as they ’will receive full global sum fees for fully registered patients’.

He added: ’What we’ve been expecting for some time is guidance from NHS England on registration arrangements. We expect that this will make it absolutely clear that all people in the country, including tourists, can access free GP services.’

An NHS England spokesperson said: ’We are currently working on guidance that reiterates the current regulations around patient eligibility and registration and will publish it in due course.’

Under the Immigration Act 2014, only UK residents with ‘indefinite leave to remain’ are entitled to free healthcare – including GP services.

So far, charging has only been implemented for elective secondary care but The Times has reported that the Government is looking at also charging for emergency care.

A DH spokesperson told Pulse a consultation on extending the charging regime will be launched in around a month’s time.

The spokesperson said: ’International visitors are welcome to use the NHS, provided they pay for it — just as families living in the UK do through their taxes. This Government was the first to introduce tough measures to clamp down on migrants accessing NHS care and have always been clear we want to look at extending charges for non-EEA migrants. No-one will be denied urgent treatment and vulnerable groups will continue to be exempt from charging.’

Dr Vautrey said the GPC was ’expecting a Government consultation on extending charging to elements of primary care’.

A BMA spokesperson said it has updated advice because ’this has long been an area of confusion for GPs, largely due to the absence of clear guidance from the DH and NHS England’.

‘Therefore while the BMA’s existing guidance remains the same, we have made it clearer for doctors to understand. We are expecting NHS England to clarify its own guidance shortly to avoid any confusion on this issue in the future,’ they added. 

Pulse revealed earlier this year that the Government plans to ask GPs to request to see EHIC cards for all patients in areas with a high population of visitors from the EU. These pilots would test the feasibility of practices routinely asking patients for documents to enable the NHS to recover the costs of primary care from their home countries in future, the DH said at the time.