Overseas patient checks could damage trust, warns GP leader

New contractual requirements for practices to identify during registration some overseas patients who may need to pay for NHS care risk damaging trust in GPs, an LMC leader has warned.

Dr Jackie Applebee: opposes GP checks on patients' immigration status
Dr Jackie Applebee: opposes GP checks on patients' immigration status

GPC member Dr Jackie Applebee warned that the new requirement announced in the 2017/18 contract was a bureaucratic burden that would hit inner city practices particularly hard.

Under new requirement agreed by the GPC, from July patients who hold non-UK European Health Insurance Cards (EHICs) or S1 forms, or who may be subject to the NHS (Charges to Overseas Visitors) Regulations 2015, will have to declare their status when they register.

Practices will then manually record patients’ status in their medical records and send a form to NHS Digital or the NHS Overseas Healthcare Team by email or post.

Under this system patients’ home countries will be charged for healthcare where relevant.

GP bureaucracy

New recurrent funding of £5m will be added to the global sum to pay for the additional workload. Dr Applebee, who chairs Tower Hamlets LMC in east London, said the bureaucratic burden for practices in inner city areas with high patient turnover ‘could be huge’.

‘Practices, to be non-discriminatory, would have to ask everyone who wanted to register. This is an unacceptable load on already struggling practices,' she said.

Dr Applebee said she was worried about the new requirement because it could ‘put illegal migrants off registering, denying them access to healthcare and posing a potential public health risk’.

She added: ‘We are health professionals, not border guards. It is the Home Office’s job to collect this data not ours,' she added. 'It will be bureaucratic and I can foresee loss of trust of GP by patients.’

‘Once these systems are in place to do this, what next?’ she asked. ‘The cost of so called "health tourism" is a drop in the ocean compared with the massive cuts being imposed [on the NHS]. These measures are merely an attempt to deflect blame from the government, are unlikely to save the NHS any money and in fact could cost the NHS money. It puts in place systems for more widespread checking.’

GP immigration role

BMA policy states that ‘NHS staff do not have any role in policing immigration’. Dr Applebee said she supported that policy and remained opposed to the new requirement.

RCGP chair Professor Helen Stokes-Lampard, who last week warned politicians against making GPs act as border guards by identifying overseas patients for NHS charging, said the new contractual requirement was a ‘straightforward exercise’ that should not be a significant burden on practices.

‘The college has been outspoken about the role of GP teams in charging overseas patients for care,' she said, ‘but we have also said that where appropriate the NHS should be able to claim back money from the countries of those patients who use NHS services.'

The government said on Monday 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'.

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.

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 EHIC holders 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.

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