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Many grassroots GPs may back the Government’s migrant levy – but they won’t if they have to police it



It’s not often you find grassroots GPs siding with Jeremy Hunt over the BMA and RCGP.

But charging migrants to use the NHS is one issue where GP representatives appear to be out of step with the majority of those they represent.

After a raft of national newspaper headlines yesterday about the costs of ‘health tourism’ – based on an independent report commissioned by the Department of Health – RCGP chair Professor Clare Gerada was quick to attack the Government’s plans to clamp down on foreigners using the NHS as ‘xenophobic’.

The BMA too has been fiercely critical of the scheme. ‘Impractical, inefficient, uneconomic and could cause unintended damage to NHS services’ was their damning verdict.

And the small but vocal group of GPs on Twitter yesterday were for the most part equally scathing. ‘Plans to recover NHS costs from immigrants are an excuse to set up the bureaucracy necessary to charge the rest of us,’ was how Hackney GP Dr Jonathon Tomlinson put it. ‘Wake up everybody.’

And yet, Pulse’s poll finding today that GPs in fact support the Government’s plans for a levy on migrants by a margin of almost two-to-one should come as little surprise.

It has long been apparent that many GPs – perhaps less vocal, possibly less urban – have grave concerns about the rules around migrant access to the NHS.

In January, Bedfordshire and Hertfordshire LMC wrote to the Department of Health and the Home Office warning about the ‘abuse of the NHS’ by overseas visitors and suggesting that so-called health tourism was a ‘national issue’. In the same month, a Pulse survey found that more than half of GPs believe that NHS entitlements are too generous.

So, is charging migrants for care that rarest of things: a radical Department of Health policy the profession can unite behind? Well, no – and for two reasons.

Firstly a significant minority – 30% of GPs, according to our poll today – are opposed to the plans, many of them vehemently. BMA deputy chair Dr Kailash Chand has written for Pulse arguing passionately against the migrant levy and its likely effect on patient care, citing his own experience as an immigrant from the Punjab. Many share his concerns.

But secondly, and more signficantly, there are the details of the policy itself. Among the respondents to Pulse’s survey who said they supported the Government’s plans, there was one common theme in their comments: just don’t make us police it.

Here the BMA, RCGP and grassroots GPs are singing from the same hymn sheet. ‘As long as the area team administers it,’ was one GP’s caveat. ‘As long as it is centrally collected and not dumped on GP practices to add unpaid tax collecting to their role,’ said another.

For his part, Jeremy Hunt insists GPs will not be forced to act as ‘border guards’. But he acknowledges there is ‘always a small amount of administration involved in GP or NHS registration’, and the fear is that even if GPs are not responsible for collecting the levy itself, the process of checking that new patients are entitled to care could add a substantial administative burden.

For now, ministers may be pleasantly surprised to discover they have many GPs’ support in principle. Exactly how the system is implemented as practices grapple with an ever-increasing workload will be crucial if they wish to keep it.

Steve Nowottny is the editor of Pulse. You can follow him on Twitter @stevenowottny.