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Should GPs charge overseas patients for care?

Dr Russell Brown


These overseas visitors are patients like any other, and so we should be paid for treating them. This is not about making a political point, this is not about GP surgeries policing eligibility for NHS care, this is not about denying care, it is about proper resourcing of work which is currently unfunded.

In Eastbourne we have many young foreign students, visiting for a few weeks, some of whom need to see a GP. Many of them are from countries with no reciprocal arrangements for healthcare. Even if there are arrangements in place, that funding doesn’t reach us. But if they apply to join our lists, we are obliged to see them, for no extra funding. This is not in the global sum: there have been no adjustments to the global sum made for temporary residents since 2004.

Why? If visiting the UK, is it unreasonable to expect them to have adequate travel insurance, as we would when going abroad? It’s not hard to arrange and it would simplify matters considerably. Then there would be no burden on the UK taxpayer to support people from outside the UK who seek access to a GP. The Government recognised this cost to the public purse in the recent Queen’s speech. A bill is to be enacted to allow charging, but the Government consultation on this only concerns charging in A&E. If it is going to happen, it needs to happen in general practice too or we will potentially be inundated.

This doesn’t need to have an impact on public health issues. If there is a person seeking care for tuberculosis for example there are already services in place to deal with it.

So if we assume that these patients will need to fund or resource their care, who should take the money? Well, given this is work happening in our practices, why should we not use that money to provide the service? And that being the case, why should we not collect the money ourselves? This would move any need for a complex claiming process, with annual uplifts and clawbacks, reconciliations, audits etc. We already take money for things like HGV medicals. It isn’t difficult or ethically dubious.

Some argue that this would be too much administration for our practices. However, EU citizens would expect to show a European Health Insurance Card. Visitors from elsewhere will be used to providing insurance details. This would not be a problem.

Importantly, collecting fees in this way is not removing resource from our NHS patients. Don’t forget opportunity costs: if a GP is seeing a foreign visitor, that is time they cannot devote to their NHS patients or to tasks necessary to the running of a busy general practice.

And if this is unpalatable to the Government or others there is already a multitude of services which could care for these patients including walk-in centres and A&E departments. So if there is no wish to fund activity in general practice, it should be directed elsewhere. We are busy enough already.

Dr Russell Brown is Chair of East Sussex LMC, co-founder of Resilient GP and a GP in East Sussex. He proposed the motion in favour of charging overseas patients at the LMCs conference in May. 

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Charging overseas visitors for care will endanger the fundamental principles of the NHS, that care is free at the point of delivery, for almost no financial benefit to us as GPs.

How much money would charging overseas visitors actually bring in? Would it even cover the costs of the extra administrative burden that this policy would place on our already overstretched reception staff? Reception staff who would have to police all patients coming to the practice to check whether they would be eligible for free care.

Previous LMCs conferences have voted overwhelmingly to reject GP practices becoming outposts of the UK Border Agency. It is disappointing that this year, a motion was passed in favour of charging overseas visitors for GP care. However it must be said that the hall was half empty because many delegates had gone for a break after a long and emotional debate on the response to the crisis in general practice.

During this debate, speaker after speaker described desperate situations, some were moved to tears. The message was unambiguous. General practice is dying, and has received a decreasing proportion of an increasingly squeezed NHS budget for far too long. The GP Forward View promises too little too late for most of us. I have no doubt that those in favour of charging overseas visitors feel overwhelmed and wish to do all they can to cut their workload. However, we are in crisis because the Government underinvests in the NHS, not because foreign visitors get free primary care.

Research tells us that migrants are a net benefit to the economy. Overall, even if they do get free general practice care, they contribute more in taxes than they receive from benefits and public services.

A lot of overseas visitors are poor and charges will stop many consulting about their health problems. Even those who object to foreigners getting free GP care must agree that it is in none of our interests for people to be in the community with untreated infectious diseases.

The Commonwealth Fund repeatedly reports that the NHS is the most cost effective health care system in the developed world yet the Government constantly complains that the NHS is unsustainable. Moves to charge overseas patients plays into their hands. Once the mechanisms are in place to charge overseas visitors it is a smaller step to charging everybody.

The NHS was set up to be free at the point of delivery, publicly funded and publicly provided. It is the envy of the world and the most popular institution in Britain. General practice is the jewel in its crown. I believe that bringing in charges for foreign visitors will rock these vital foundations for very little, if any, financial benefit.

Dr Jackie Applebee is chair of Tower Hamlets LMC and a GP in east London