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  • Details of flu vaccine ordering for 2018-19 season published

    Details of flu vaccine ordering for 2018-19 season published

    Thursday, 08 February 2018 10:52
  • 'Easy access' initiatives could fragment GP services, warns Nuffield report

    'Easy access' initiatives could fragment GP services, warns Nuffield report

    Wednesday, 07 February 2018 14:29
  • Restricted range of gluten free products can still be prescribed if CCGs agree

    Restricted range of gluten free products can still be prescribed if CCGs agree

    Monday, 05 February 2018 11:56
  • NHS England prepares to launch ACO consultation

    NHS England prepares to launch ACO consultation

    Wednesday, 31 January 2018 10:40
  • Improvement seen in flu vaccine uptake for start of 2017-18 season

    Improvement seen in flu vaccine uptake for start of 2017-18 season

    Friday, 26 January 2018 19:31

a pound imageOctober 23 2017

New regulations requiring hospitals to charge people upfront if the patient cannot prove entitlement to free NHS treatment could put more pressure on general practice.

A BMJ editorial has warned that “with primary care remaining free to all in England, the increased workload on already overextended general practices is likely to be unmanageable.”

The NHS (Charges to Overseas Visitors) (Amendment) Regulations have come into force on Monday 23 October. NHS Trusts and community care providers now have a legal obligation “to establish whether a person is an overseas visitor to whom charges apply, or whether they are exempt from charges,” says the Department of Health. In addition: “NHS Providers and non-NHS Providers are legally required to recover charges that are not immediately necessary or urgent in full, in advance of providing them.”

Until now, the notion of charging patients not eligible for NHS care in advance had been a recommendation, not a legal obligation. The new regulations also require providers to record when a person is an overseas visitor on the Summary Care Record application.

Concerns about the impact of the new regulations are raised in the BMJ article by Lucinda Hiam, health adviser to Doctors of the World, and Martin McKee, Professor of European public health at the London School of Hygiene and Tropical Medicine.

They note: “The NHS’s founding principles—to meet the needs of everyone, to be free at the point of delivery, and to be based on clinical need, not ability to pay—were restated as recently as 2011, when a ‘wider social duty to promote equality’ was added.”

However, under the new system, “anyone, including children, attending healthcare facilities in England who is unable to establish their entitlement to free care will be charged upfront for the estimated cost of treatment. If they are unable to pay, treatment may be refused.” The authors question how people, such as the homeless or those with mental health problems, will be able to prove their entitlement to care.

Department of Health guidance is set out in a 34-page document intended “primarily for use of those individuals in NHS organisations, including Overseas Visitor Managers (OVM), patient facing administrative teams, administrative staff and finance managers, who have responsibilities associated with the identification and charging of those patients not eligible for free NHS services.”

Only clinicians will be able to make an assessment as to whether a patient’s need for treatment is immediately necessary, urgent or non-urgent, says the guidance. It defines ‘immediately necessary treatment’ as “that which a patient needs promptly:

  • to save their life; or
  • to prevent a condition from becoming immediately life-threatening; or
  • to prevent permanent serious damage from occurring.”

In addition; “Urgent treatment is that which clinicians do not consider immediately necessary, but which nevertheless cannot wait until the person can be reasonably expected to return home. However, urgent treatment should also always be provided to any person, even if a deposit has not been secured, and must never be delayed or withheld.”

Links:
Department of Health: 'Guidance on overseas visitors hospital charging regulations’          
‘Upfront charging operational framework’ document                  
L Hiam and M McKee. Upfront charging of overseas visitors using the NHS’. BMJ 2017; 359: j4713                 

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