BACKGROUND: A PATIENT, Ms D, has been undergoing treatment for pancreatic cancer for several weeks. Her practice has recently been informed by the UK Border Agency that she failed in her bid for residency a number of months ago and, as such, is officially an “illegal immigrant” who is not legally entitled to free NHS care.
The practice has a policy of checking all patients’ identification and any relevant visas in order to provide NHS care only to those who are entitled to it. Unaware of Ms D’s status, however, the practice had registered her, and her GP then referred her for secondary care.
The practice manager, Mr L, has since been contacted by a hospital official who is seeking confirmation that, given Ms D’s illegal status, the practice will fund her care. Mr L is unsure of how to proceed with providing care for Ms D and contacts MDDUS for advice.
ANALYSIS/OUTCOME: An MDDUS adviser discusses the issue with Mr L and agrees that it would be unreasonable to expect the practice to fund Ms D’s secondary care. The practice are advised to continue providing any immediately necessary treatment to the patient and Mr L should contact the local clinical commissioning group (CCG) to clarify what this level of treatment would involve. The CCG should also be able to explain who is responsible for the cost of providing Ms D’s care.
Until the CCG reaches a decision, the practice should continue to keep Ms D on their list and to meet her clinical needs as far as possible under the circumstances. The practice is reminded of General Medical Council guidance which states that doctors must “never discriminate unfairly against patients or colleagues”, adding: “You must give priority to the investigation and treatment of patients on the basis of clinical need, when such decisions are within your power".
The adviser also cautions Mr L that MDDUS has defended cases on behalf of members where refusing or delaying treatment on the basis of eligibility has led to claims of negligence.
- Patients must be treated on the basis of clinical need, rather than on their eligibility for free NHS care.
- Ensure that any requests for identification, etc, are made of all patients equally.
- Assessments of eligibility for care should be made by non-clinical staff such as the CCG/trust/health board.