GPs should charge non-EU migrants for all primary care ‘at the point of delivery’ – including emergencies – unless they have paid a new levy of between £200 and £500 per year, a Government consultation suggests.
In a major shake-up of the entitlement non-EU migrants have to NHS treatment, the Department of Health proposes all those in the UK for a ‘limited period’ would have to opt-in and pay the levy for free NHS treatment upon entering the country.
If they do not, then the Government suggests that they should have to pay for all primary care treatment up-front, although the costs from emergency care in hospital would be recouped later.
In order to do this, the DH proposes that NHS numbers and GP records should ‘differentiate chargeable and exempt persons’ and there will be a new system where initial ‘NHS registration’ is a separate process from registering with a specific GP practice.
The DH says the plans are provisional – and it would also consider a model of private health insurance – but that it favours introducing the levy.
The proposals have surprised the GPC, who said it raised ‘deep ethical concerns’ and would place GPs in an ‘inappropriate position’.
The document says: ‘We propose to restrict entitlement to free NHS treatment to those non-EEA nationals with a permanent relationship with the UK. Building on this we propose that those who come for a limited period should make an explicit contribution to the costs of their healthcare unless or until they are given indefinite leave to remain.
‘These temporary migrants might pay a migrant health levy on entry to the country, or be required to hold insurance to cover the costs of their NHS treatment.’
It adds: ‘Temporary migrants paying the migrant health levy would have access to primary care without further charge. However for other short-term migrants who request non-emergency access (perhaps to monitor current chronic conditions while visiting, or for illegal migrants) a direct charge could need to be levied.’
It suggests that GPs could charge a payment per consultation or other service, an annual service fee or another standard fixed fee. It also says that there may be ‘incentives’ introduced for GPs to collect the charges.
The consultation document says: ‘There should be an appropriate and integrated set of new financial and other contractual incentives to maximise the number of patients who are appropriately charged, and to maximise revenue recovery from appropriately charged patients.’
However the Government has admitted it doesn’t know the actual cost of ‘health tourism’ and alongside the consultation has commissioned an ‘audit’ of NHS use by visitors and temporary migrants which will collect information directly ‘from staff on the front line’ and report in the autumn.
Health secretary Jeremy Hunt said: ‘We are clear that the NHS is a national health service not an international health service and I am determined to cut out abuse in the system.
‘The NHS is a national treasure and we need to work with the entire health system to develop plans and make sure it is sustainable for years to come.’
But the GPC condemned the plans, saying they struck ‘at the heart of the ethical duty of the doctor’.
GPC negotiator Dr Chaand Nagpaul said: ‘I think it would be wholly inappropriate to put GPs in a position to charge patients who have urgent health needs.
‘The danger is that patients with serious illnesses will not present to a GP. They may actually become more ill and incur greater cost to the NHS through requiring hospitalisation or emergency treatment. It also incurs a risk of spreading illness in local communities, for example tuberculosis.
‘I thought that they would still say that GPs should charge patients for routine healthcare, but that it specifically says that urgent care should be charged is the bit I find really striking at the heart of the ethical duty of the doctor. That is extremely worrying and raises deep ethical issues.’
While the consultation specifically focuses on the NHS in England, the Government said some immigration aspects are applicable across the UK, with a separate discussion to be held with the devolved health administrations in Wales, Scotland and Northern Ireland. The legislative changes will be put through as part of the Immigration Bill that is currently going through Parliament.