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Q&A: Charging migrants for NHS care

Who can be charged for using NHS services?

Hospitals can charge visitors to the UK for services under the NHS Charges (Overseas Visitors) Regulations. Due to EU regulations and other international healthcare reciprocal agreements, some visitors may be exempt from charging if the treatment cannot wait until they were planning to return to their home country. This includes visitors from the European Economic Area (EEA) who carry a European Health Insurance Card (EHIC).

Can GP practices ever charge visitors to the UK?

The NHS Charges (Overseas Visitors) Regulations do not cover general practice. There is currently no mechanism for charging  patients for GP care.

Guidance from the Government says: ‘GPs have discretion to accept any person, including overseas visitors, to be either fully registered as a NHS patient, or as a temporary resident if they are to be in an area between 24 hours and three months. There is no minimum period that a person needs to have been in the UK before a GP can register them. Furthermore, GPs have a duty to provide free of charge treatment which they consider to be immediately necessary or emergency, regardless of whether that patient is an overseas visitor or registered with that practice.’

Is this all about to change?

New legislation adopted last year (the Immigration Act 2014) means that non-EEA migrants have to be current residents with indefinite leave to remain to qualify for free NHS treatment. The Government is currently working on rolling this out in practice under the Visitor and Migrant NHS Cost Recovery Programme.

So in principal with this new piece of legislation these migrants could be charged for all NHS services, including GP services. However, there isn’t any mechanism in place for how to do this yet, or any decision on how much it should cost.

Is the Government going to ask GP practices to treat non-EEA temporary migrants against a charge?

The Government hasn’t decided this yet, or at least it hasn’t decided how. In 2013 it suggested non-EEA temporary migrants could pay a levy of a few hundred pounds on entry to the UK which entitled them to free NHS treatment during their stay but a year ago the Government backtracked on the suggestion. Most recently the Government said charging for GP services was ‘deprioritised’ but now the Government has confirmed it will begin new consultations on charging for primary care this spring.

So why ask GPs to check if patients carry EHIC?

In the meantime, the Government is looking at how to better identify patients that should be charged, including in hospitals. Government guidance already says that it ‘can be helpful to ensure that local GPs understand’ that being registered with the practice doesn’t necessarily mean that the patient is eligible for free hospital treatment ‘so that they identify in the referral letter any patient whom they believe may be an overseas visitor’. It is, however, not the GP practice’s duty to actually check if a person is eligible for free hospital treatment – that is down to the hospital.

What do the BMA think about this?

GP leaders are concerned that having to check the migration status of patients would add to practices’ workload. However the GPC has said it would support a process that identified non-eligible patients without putting too much pressure on practices and is therefore supportive of a pilot where practices ask EEA citizens to produce an EHIC.