The DH has said it will push ahead with proposals to extend charges for overseas visitors to some primary care services in a bid to save 'up to £500m'.
In a consultation response published on Monday, the government said that 'primary care has an important role in establishing chargeable status and charging overseas visitors and migrants'.
GP leaders warned that introducing charging was 'fraught with difficulties' and could cost more than it saves. The government's proposals come just days after the RCGP warned against turning GPs into border guards.
The government has pledged to consult further with the RCGP and GPC on how best to extend charges into primary care, before making changes to contracts and legislation to support the move.
Charging for overseas patients will be extended for other parts of the NHS from April, but the government said primary care's charging role would be 'implemented over a longer timescale'.
While GP and nurse consultations would remain free for all under the plans, charges could be extended to GP services such as phlebotomy, spirometry, minor surgery and physiotherapy.
The charges would apply to all overseas visitors except holders of the European Health Insurance Card (EHIC) and those who have paid a £200 Immigration Health Surcharge.
Diagnostics and treatments for certain infectious diseases will be exempted for the protection of public health.
The roll-out of the new regime will be phased, with primary care charges subject to further consultations because of what DH said were the ‘challenges’ of the plan.
GP leaders said they would engage with any future consultation but warned that charging patients in primary care could be difficult and have unintended consequences on public health.
The DH said in today’s report that the best way to determine whether patients are chargeable was when they register at a GP practice.
'We will work with stakeholders,' the report said, 'to consider how best to extend the charging of overseas visitors and migrants into primary care. We believe that this starts with being able to determine whether a patient is chargeable for secondary care when they register at a GP practice and that putting in place the processes for charging for primary care services will take longer to implement.'
From April non exempt overseas visitors, who are already chargeable for non-urgent secondary care, will face fees for secondary and community care provided outside of hospitals and NHS funded secondary care provided by non-NHS bodies.
Hospital trusts will be required to take upfront payment for non-urgent care. And NHS bodies will be required to identify and flag an overseas visitors’ chargeable status.
The government also refused to rule out extending charges to A&E, ambulance, urgent care and walk-in services, saying it was exploring the feasibility of the proposals and would report back later in the year.
Health secretary Jeremy Hunt said: ‘We have no problem with overseas visitors using our NHS – as long as they make a fair contribution, just as the British taxpayer does.
‘So today we are announcing plans to change the law which means those who aren’t eligible for free care will be asked to pay upfront for non-urgent treatment.
‘We aim to recover up to £500m a year by the middle of this parliament – money that can then be reinvested in patient care.’
GPC deputy chair Dr Richard Vautrey said: ‘Charging patients for primary care is fraught with difficulties and complexities, could cost more than is saved and could lead to unintended consequences by putting the wider public at risk if infectious diseases are left untreated.'
BMA chair Dr Mark Porter said: ‘It is right that we ensure all patients are eligible for NHS care and that we have in place a working system to recoup the cost of treatment from patients not ordinarily resident in the UK.
‘However, it’s hard to see how these new proposals will operate in practice, especially as they are to implemented by law. There is no detail as to how upfront charging will be introduced from scratch in just three months in an NHS already unable to cope with normal operations. We need to be careful not to demonise overseas patients or sow chaos and confusion within the NHS. Doctors and nurses cannot be expected to arbitrarily decide whether a patient gets treatment or not.
‘There is patchy evidence that this kind of system will achieve £500m in savings and even if it did, this would not in any way solve the enormous funding crisis in our health service that the government has for too long ignored. Ministers should not mislead the public into thinking this will result in a cash windfall for the NHS, but must address the wider funding shortfall in the NHS, which has left it understaffed and struggling to care for its patients.’