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moneyDecember 9 2015

Concerns have been raised over the potential for confusion that proposals to extend charging non-UK residents for NHS services may cause.

On Monday, the Health Secretary Jeremy Hunt announced a consultation on charging overseas visitors and migrants who use the NHS. It includes proposed new primary care eligibility and exemption arrangements for residents of the European Economic Area (EEA) with or without a European Health Insurance Card (EHIC), as well as for people from non-EEA countries.

Currently, the visitor and migrant NHS cost recovery programme established in July 2014 has focused on improving identification and cost recovery from chargeable patients in hospitals. This new consultation is seeking views on proposals to extend the charge to a certain aspects of primary and secondary care and community healthcare, as well as looking at current residency requirements.

The RCGP has warned that the extended programme will have to be clear about how charges will be applied as it may deter sick people from seeking medical help. Professor Nigel Mathers, Honorary Secretary for the RCGP, said: “One of the founding principles of the NHS is that healthcare is free at the point of need and limiting access would fundamentally change that.

“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 ... 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 Prof Mathers said the RCGP was pleased that the plans will not extend to emergency care and routine GP appointments, “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.”

Announcing the consultation, Mr Hunt told MPs: “The proposed extension of charging will not affect free healthcare at the point of use for permanent residents of the UK.

“The proposals explored within the consultation aim to support the principle of fairness by ensuring those not resident of the UK who can pay for NHS care do so. The proposals we are consulting on do not intend to restrict access, but aim to ensure everyone makes a fair contribution for the care they receive.

“We propose that the most vulnerable people, including refugees, remain exempt from charging. Furthermore, the NHS will not deny urgent and immediately necessary healthcare to those in need, regardless of residency. We also propose that exemptions from charging will also remain in place for illnesses that pose a risk to public health.”

For primary care, the consultation document notes the previous commitment to keep all GP and nurse consultations free for all. “This is on public protection grounds, as early identification of diseases such as TB and Ebola will help prevent or lessen the risk of any potential outbreaks,” it says.

“We do not want a situation to arise where the health of the public is put at risk because someone is deterred from seeking diagnosis because they are worried about being charged to see a GP. We intend to uphold that commitment and maintain consultations in primary care as free at the point of use. We are seeking views in this consultation as to whether this is the right approach.”

In addition, the consultation includes a list of patients who would be included in a range of charge-exempt categories as well as conditions for which diagnostic tests would remain exempt from charge.

The Department of Health says any potential income will contribute to its aim of recovering up to £500 million per year from overseas migrants and visitors by 2017-18.
Responses to the consultation should be submitted by March 7 2016.

Links:

DoH announcement

DoH ‘Making a fair contribution’

Hansard -House of Commons statement

RCGP response

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