Extended charges for overseas patients criticised

PLANS to extend charges for overseas visitors requiring GP and emergency medical services could discourage some patients from seeking healthcare and lead to increased administration and bureaucracy, says the BMA.

The Department of Health has launched a public consultation on extending existing charging arrangements for overseas visitors and migrants for their use of the NHS in England. The proposals call for the introduction of charging in primary care, ambulance services and A&E, which the Government claims will bring in an extra £500m to the NHS.

Dr Mark Porter, Chair of BMA Council, said: "It is important that anyone accessing NHS services is entitled to do so, especially as the health service is under intense pressure from a combination of rising patient demand and falling resources. However, the government’s proposals could create unintended drawbacks for the NHS and patients.

"Not only will this arrangement cause confusion amongst patients, it will also require GPs and hospital doctors to spend more time on the paperwork and bureaucracy needed to regulate these charges. This could mean the administration of the new system could end up costing more to run than it collects in revenue.

"Most importantly, there is a real risk that some migrants and short term visitors who desperately need care could be discouraged from approaching the NHS if they cannot pay the charges. 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."

Visitors from outside the European Economic Area (EEA) already pay for planned non-urgent hospital care and if settling in the UK for longer than six months must pay a "health surcharge" as part of their visa application.

Under the new proposals charges would be extended for care received from GPs, including diagnostic tests and scans, and care in A&E as well as other health services including ambulance care. Vulnerable groups, including refugees and asylum seekers, would continue to be exempt from charges.

Health Secretary Jeremy Hunt said: "We want to make sure that everyone makes a fair contribution to services, by extending charging to make sure visitors pay for the care they receive.

"This government was the first to introduce tough measures to clamp down on migrants accessing the NHS and these changes will recover up to £500m per year to put back into frontline patient care."

But the RCGP is critical of the plans. Professor Nigel Mathers, Honorary Secretary for the college, 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 be 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.

"We are pleased that these plans will not extend to emergency care and routine GP appointments, but we are concerned that a system of charging for some services and not others will lead to confusion amongst patients and may deter them from seeking medical care when they are sick."

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