Policing migrant patients

The recent Queen's Speech once again raised the issue of healthcare and immigration status. So what are the obligations in primary care?

A RENEWED focus on migrants’ access to the NHS emerged in the latest Queen’s Speech.

A prominent feature of the Royal address was plans for new laws to curb immigration. Among the ideas proposed are restrictions on migrants’ access to the NHS while temporary visitors would be expected to “make a contribution” to the cost of their care, either with their own money or through their government.

The proposals have prompted a number of calls to MDDUS from members seeking clarification of the duties of doctors and dentists when treating migrants, those who have been refused asylum or who are living in the UK illegally.

Currently, GPs in England have discretion to provide treatment to overseas patients, either fully registered as an NHS patient, or as a temporary resident if they are to be in an area between 24 hours and three months.

However, this does not give a person automatic entitlement to free NHS hospital treatment. Indeed, under current rules, detailed on p.52 of the Department of Health’s Guidance On Implementing the Overseas Visitors Hospital Charging Regulations, GPs are asked to make this fact clear to patients and to “identify in the referral letter any patient whom they believe may be an overseas visitor”.

The DoH goes on to say that these guidelines should not discourage GPs from referring their patients to the relevant NHS body, adding: “It is the relevant NHS body’s duty, not the GP’s, to establish entitlement for free hospital treatment.”

The DoH is also clear that “GPs have a duty to provide free of charge treatment which they consider to be immediately necessary or emergency, regardless of whether that patient is an overseas visitor or registered with that practice.”

In Scotland, the government explains (in guidance Overseas Visitors’ Liability To Pay Charges For NHS Care And Services) that charging for NHS primary care services, other than certain dental and optical services, is not permitted under overseas visitors regulations. The guidance goes on to state that it is for GP practices to use their discretion when deciding whether to register an overseas visitor or to treat them privately (being sure to take into account the terms of NHS GMS contract regulations). GP practices also have the option to remove patients from their lists “if they have evidence that they have been out of the country for more than three months.”

Exemptions allowing asylum seekers and refugees to register with a GP and receive free NHS hospital care apply in all four UK health administrations. These rules vary across the devolved nations.

Guidance from the British Medical Association also helps to clarify the situation. It states: “Practices are not required to check the identity or immigration status of people registering to join their lists and there is no obligation on prospective patients to provide evidence in this regard. There may be practical reasons why GP practices might want to confirm the identity of patients registering at a practice but practices must ensure that any requests for identification are asked of all patients who register to avoid discrimination."

General Dental Council guidance Standards from dental professionals does not specifically mention the treatment of migrants but emphasises the importance of equality. It states: “Treat patients fairly and in line with the law. Promote equal opportunities for all patients. Do not discriminate against patients or groups of patients because of their sex, age, race, ethnic origin, nationality, special needs or disability, sexuality, health, lifestyle, beliefs or any other irrelevant consideration."

Following last month’s Queen’s Speech, business secretary Vince Cable was interviewed on BBC Radio 4’s The World at One and asked whether the proposed new laws would mean GPs having to check patients’ passports before agreeing to treat them. He said that “checks of various kinds” were one option being considered but the details had yet to be finalised.

ACTION: General practices are not expected to “police” patients’ immigration status and have the discretion to treat overseas patients.