Forcing practices to act as 'border guards' breaks GP-patient trust, warns RCGP

The RCGP has rejected MPs' call for practices to do more to identify overseas patients not eligible for free hospital care.

DH advises GPs to flag up overseas patients in referrals (Photo: JH Lancy)
DH advises GPs to flag up overseas patients in referrals (Photo: JH Lancy)

College chair professor Helen Stokes-Lampard said said GPs should not in any way ‘assist with border control’ and rejected a suggestion by an MPs’ committee that practices could share information on patients’ immigration status to help recover costs from chargeable patients. The college warned against exaggerating the amount of money that could be recovered.

The House of Commons public accounts committee called for NHS England to clarify GPs' role in identifying chargeable patients and to issue guidance by June.

Currently overseas patients are eligible for charges for routine secondary care, while emergency and GP care is exempt.

NHS funding

The MPs’ report called on NHS bosses to do more to recover costs from patients. Around £289m was recovered in 2015/16 with a target of £500m a year by 2017/18.

The committee said it was not confident that the DH was doing enough to recover costs and was hampered by the NHS’s failure to properly identify eligible patients.

DH officials told MPs that while GPs were not contractually obliged to identify overseas patients it recommends they do so in referral letters.

The committee said ‘GPs could do more to help the NHS increase the amounts recovered for treating chargeable overseas patients’.

It said there was scope for practices to report patients from the European Economic Area and Switzerland through the European Health Insurance Card scheme to allow the UK to recover costs. The DH, it said, was ‘keen to support any GP surgeries that wish to pass on information, but there are no systematic arrangements in place for GPs to do so’.

GP confidentiality

But Professor Stokes-Lampard said: ‘It is the role of GPs and our teams to deliver care to our patients, free at the point of need, regardless of their individual circumstances. We must stop perpetuating this idea that general practice should, in whatever way, assist with border control.

‘Patients share information with their GP on the mutual understanding that it will remain confidential. We are very concerned that any process that undermines that crucial trust between doctors and patients will both deteriorate the doctor-patient relationship, and deter vulnerable people from seeking medical assistance when they need it.

‘The entire NHS is in a dire financial situation, but we shouldn’t exaggerate the amount of money that can be raised through GPs getting involved in cost recovery - particularly when balanced against the administrative and training costs that introducing such a process would incur.’

BMA chair Dr Mark Porter said: ‘It is important that those accessing NHS service are eligible to do so and that we recover the costs for treating overseas visitors. The systems to do this need to be practical, economic and efficient and must not jeopardise access to healthcare for those who need it.

‘Any charging systems should not prevent sick and vulnerable patients receiving necessary care, otherwise there may be serious consequences for their health and that of the public in general.’

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