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Health tourism: Survey suggests GP support for upfront charges

More than three-quarters of GPs are in favour of charging foreign visitors for accessing primary care, a Pulse survey has found

The findings come as the Department of Health prepares to launch consultations to explore ways to claw back money from overseas visitors who use GP services – although it has not yet confirmed whether it will include charging migrants directly.

Health Tourism - online

Practices with high populations of EU migrants will be asked to check whether patients are eligible for free NHS care under pilots due to launch later this year.

The pilots will involve GP practices in 10 areas asking all new patients if they have a valid European Health Insurance Card (EHIC), which entitles them to access primary care and certain secondary care treatment without an up-front charge. Practices will also be asked to collect data from UK state pensioners resident elsewhere in the EEA under the pilot scheme.

At the moment, there are no mechanisms for charging foreign patients for accessing primary care. However, this might change. Under new legislation – the Immigration Act 2014 – only UK residents with ‘indefinite leave to remain’ will be entitled to free healthcare, including primary care. This has given the DH the green light to explore the potential of covering the costs of overseas visitors and temporary residents accessing primary care.

A DH spokesperson tells Pulse the Government is ‘absolutely committed to improving the way the NHS recovers costs from international visitors for primary care’, after the Government put the annual cost of what it labels ‘health tourism’ at around £200m.

There is no guarantee these measures will include direct charging, but this could form part of a consultation that will launch this spring, with the DH spokesperson indicating that any plans for direct charging ‘will require further consultation’.

It’s not the first time the DH has raised the issue. Last year, the Government considered a suggestion to charge non-EEA migrants a £200-500 levy on entry to the UK, or when they renewed their visa, for access to all routine and emergency care – an idea a Pulse survey in 2013 found 55% of GPs supported. But the DH was forced to drop the idea, admitting it would probably cost more to administer than would be recovered in charges.

The Pulse survey reveals GPs are behind efforts to bring in more money from ‘health tourism’. Of the 640 respondents, 494 (77%) said they supported up-front charges for foreign visitors wanting to access primary care, with only 14% coming out against it.

Several respondents said UK citizens have to pay to access care abroad, so the same should apply here.

Health Tourism pie chart- online

Dr Zishan Syed, a GP in Maidstone, Kent, says: ‘It is a sad reality but there is abuse of the NHS by foreign visitors. It is only fair they pay up front if they are not entitled to free care. The Government must stop anyone taking advantage of a system already under immense pressure.’

Dr Niall Finegan, a GP in Salford, puts it more bluntly: ‘We do not get free care abroad.’

But many GPs in the survey said there had to be a non-bureaucratic solution to prevent GPs becoming ‘tax collectors’ or ‘border police’. A DH spokesperson said this was a concern the Government was aware of, saying: ‘We’re planning to pilot different ways of doing this effectively without burdening busy GPs.’

The EHIC pilots – as revealed by Pulse – form part of these efforts, even though patients will not be charged at first.

The GPC is working with the DH on the plans. GPC negotiator Dr Dean Marshall says the pilot will aim to get GPs ‘used to asking for’ EHIC cards routinely with a goal of eventually recovering costs from patients’ home countries.

But not everyone is in favour of charges. Dr Kailash Chand, BMA deputy chair and a retired GP in Lancashire, warns: ‘This plan will at best reduce doctors to the role of debt collectors. At worst it will deter them from registering migrants and asylum seekers, as well as setting up a new system of charging that could be extended to others.’

The plans have also been criticised by former NHS England chief executive Sir David Nicholson, who says the impact of health tourism on the NHS has been ‘massively exaggerated’.

GPC view: ‘We need to see how much work it is’

Dr Dean Marshall

Clearly there is a huge amount of NHS money being spent on people who are not entitled to it. [But] we need to pilot European Health Insurance Card checks in GP surgeries and see how much work it is. It will be extra administration potentially, but we hope it will clarify who is and who isn’t entitled to NHS care.

What we have been absolutely clear about is that this isn’t about the GPs becoming an immigration force and policing the system. It is about the administrative work – how it can be done with the least burden. Of course, an electronic solution would be what we are looking for.

Dr Dean Marshall, GPC executive member.


Q&A: Migrant charges for NHS care

Who can be charged for using NHS services?

Hospitals can charge visitors to the UK for services, although some treatment may be exempt if it cannot wait until the patient planned to return to their home country. Visitors from the European Economic Area (EEA) who carry a European Health Insurance Card (EHIC) also do not have to pay for emergency treatment.

Can GP practices ever charge visitors to the UK?

Current Government guidance says GPs have a duty to provide treatment free of charge, ‘regardless of whether that patient is an overseas visitor’.

However, under the Immigration Act 2014, migrants can be charged for all NHS services, including GP services. But there isn’t a mechanism in place to do this yet, or any decision on how much the charges should be.

Is the Government going to claw back money from migrants who access GP care?

The Government hasn’t decided this yet – or at least it hasn’t decided how to do it. 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 – including GP consultations – during their stay. But ministers backtracked on the suggestion last year.

Most recently, the Government said charging for GP services had been ‘deprioritised’. But it said it will begin new consultations this spring on recovering the costs of overseas visitors using primary care.

How will GPs fit into these plans?

The Government’s guidance already says that it ‘can be helpful to ensure that GPs understand’ that being registered with the practice doesn’t necessarily mean the patient is eligible for free hospital treatment. But now, Pulse has learned that the DH is starting pilots that will see GP practices asking overseas visitors for their EHIC to ensure they are eligible for free care. 

So will GPs need to charge those not eligible for care?

No. No one will be charged under the pilots and it ultimately remains the hospital’s duty to check if a person is eligible for free hospital treatment, not the GP’s.