As a volunteer GP at Doctors of the World’s drop-in clinic in Bethnal Green, I help excluded migrants and refused asylum seekers who are struggling to access NHS services that they are fully entitled to. They face barriers to care such as being asked for proof of address and ID that they simply do not have. Many are suffering from trauma caused by trafficking, conflict, torture or persecution. The vast majority have been living here for many years and only come to us because they are desperate.
The UK Government is considering making it even more difficult for these patients by charging them for primary care services, as well as A&E and ambulance services. Migrants and overseas visitors are currently charged for secondary care services at 150% tariff. I fear charging for primary care will have a detrimental impact on vulnerable patients.
I am reminded of an Afghan couple I saw a few months ago. In their late 60s, their asylum application had been refused and they were homeless and relying on the support of religious organisations for shelter. The wife struggled to care for her husband who had had brain surgery to remove a tumour, and carried his medication around with him in a dirty carrier bag. They had already been turned away from several GP surgeries. The introduction of charges would make accessing healthcare impossible for this couple.
As a GP in a busy practice, I am also concerned about the additional burden charging would place on practices. There is no suggestion that GP practices will get to keep the revenue recovered, yet receptionists will have to identify chargeable patients by asking immigration-related questions and raise invoices. I am sceptical that this scheme will manage to recover the amount of money it intends to for the NHS. Experience tells me this patient group will not be able to pay so will avoid GP practices instead. 90% of the patients at Doctors of the World’s drop-in clinic live below the poverty line.
Charging poor and vulnerable patients also raises medical ethics issues. GPs will have to make clinical decisions based on a patient’s ability to pay. As a doctor I have a duty to provide appropriate medical care to all people without discrimination. What do I do when my patient is too poor to pay for diabetes care?
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