07.12.15
DH explores extending overseas care charge to primary care
The government wants to extend the existing NHS charges for overseas and non-EU visitors to primary care, including the possibility of charging for historically free GP services.
In a public consultation launched today (7 December), the Department of Health reiterated its goal to save up to £500m per year from charging overseas migrants and visitors by 2017-18, helping to contribute to the £22bn savings it has planned for the health service.
Achieving this, it said, can only be done by “encouraging fair contributions from visitors and migrants, and through encouraging behaviour changes in the NHS”.
Building on charges to secondary care implemented in 2013, the government said in its consultation document that it needs to “keep the momentum going” by extending charging into some aspects of primary care, A&E and all providers of secondary care.
“It is fair that people who are in this country for a short time, and are not ordinarily resident here, should meet the costs of all NHS healthcare they receive. Our health system as its stands is still overly generous to those who only have a temporary relationship with the UK, particularly in comparison with what UK residents can expect when they travel aboard. Ultimately, this is a cost borne by UK residents and taxpayers,” it said.
As well as asking whether the government should extend secondary care charges to primary and emergency care, the consultation document also discusses the issue of cost recovery from EEA residents visiting the UK who do not have a European Health Insurance Card (EHIC) and whether GP and nurse consultation should remain free for all.
It is consulting relevant groups on how this could be done without disproportionately hitting those with health inequalities or from vulnerable sectors of society. “It is also right that we look across the system to ensure that rules on eligibility for other costly services based on residence in the UK are tightened. An example of this is eligibility for the EHIC, which entitles the holder to necessary treatment in other European countries.”
The department said it is tightening the process by which people apply for the card and widening the checks made on its use – a clampdown particularly motivated by allegations that a supposed ‘loophole’ in issuing the card was allowing non-UK residents to charge the NHS for healthcare received elsewhere in the EEA.
Following consultation, the department will work with its partners to develop an implementation strategy for 2016-18.
Extra bureaucracy and service confusion
Responding to the consultation, Professor Nigel Mathers, honorary secretary of the Royal College of GPs, said that one of the “founding principles of the NHS” is that healthcare is free and that “limiting access would fundamentally change that”.
“Doctors enter medicine to deliver care to patients – not to check that people are entitled to free care, before they receive treatment,” he said.
“General practice is already under immense resource and workforce pressures so it is imperative that GPs and our teams do not find ourselves acting as immigration control and being burdened with even more bureaucracy.
“While it is important that the NHS is not abused and measures need to be taken to tackle health tourism, GPs have a duty of care to all people seeking healthcare and cannot be expected to police the system or prevent people from getting medical help when they are at their most vulnerable.”
While Mathers said the royal college was pleased that plans would not apply to routine GP appointments, he expressed concern that a system of charging for some services and not others would “lead to confusion amongst patients and may deter them from seeking medical care when they are sick”.
The BMA agreed that the arrangement would discourage patients from seeing the NHS and cause confusion, as well as require GPs and hospital doctors to spend more time on paperwork and bureaucracy needed to regulate charges.
Dr Mark Porter, chair of the BMA Council, added: “There could be particular confusion over access entitlements to emergency care services, given the proposals introduce charging for A&E visits yet say no patient will be turned away if they need care.
“Similarly, while patients won’t have to pay for GP appointments, they may have to pay for follow up tests and treatment. We cannot have a situation where any patient with a serious health need is deterred from seeing a doctor, especially if their condition raises a potential public health risk.”
(Top image c. Sean Dempsey/PA Images)