Overseas patient charges could leave GPs swamped as last bastion of free NHS

Workload in general practice will 'become unmanageable' should plans go ahead to charge patients who are not lawful UK residents for hospital care, GP campaigners have warned.

Doctors of the World medical adviser Dr Lucinda Hiam (Photo: Pete Hill)
Doctors of the World medical adviser Dr Lucinda Hiam (Photo: Pete Hill)

Proposals to force secondary care to charge overseas patients for treatment will see primary care services become the last truly free area of the NHS – which could be the last straw for 'already overextended general practices', a GP adviser to a leading humanitarian group warned.

Dr Lucinda Hiam, a medical adviser at humanitarian group Doctors of the World, urged GPs at the RCGP annual conference 2017 last week to fight against the proposed changes.

The changes – set to bed in from 23 October – will oblige secondary care providers to check the immigration status of patients to ensure they are lawful UK residents before they treat them.

If they cannot prove they lawfully reside in the UK, they should be deemed ineligible for NHS care and charged up front before they can receive treatment, according to the updated principles of the NHS.

They will be charged at 150% of the standard NHS rate if they do not have insurance, according to NHS Choices.

If they cannot pay, treatment may be refused – unless it is considered urgent or immediately necessary.

NHS charging

Dr Hiam – alongside public health professor Martin McKee – called for the proposals to be withdrawn in an editorial published in the BMJ.

They warned that 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 – are under threat as a result of these measures.

Challenges will be two-fold for healthcare teams, they said – firstly, they must establish whether a patient is entitled to NHS care, which can be complex.

And if a person is not entitled to care, clinicians must decide whether to treat them – which has risks if they get it wrong.

They could be subject to disciplinary action if they breach guidance and treat people not entitled to care. But then if they deny patients treatment they need, they may be acting unlawfully under the Human Rights Act.

Dr Hiam warned at the RCGP conference – in a talk on how GPs can be activists – that patients may keep presenting at their GP as a result of this, as it will become the ‘only free place to go’.

‘It will put us in an impossible position,’ she said. ‘We've done all we can, we refer them onwards for treatment – but they’ll have nowhere to go.

GP workload

‘How will GPs cope when we’re the only remaining free service? And do we want this trickling down to us next year? I certainly don’t.’

She said the increased workload on already overextended general practices is 'likely to be unmanageable'.

‘If you feel as I do as a professional that this goes against the Hippocratic Oath, we need to think how we’re going to fight back.

‘Immigration and healthcare are separate policy – my right to treat people has nothing to do with immigration policy in our country, they need to be kept separate.

‘They’re taking silence as agreement. Please tweet about it – tell them you are angry about these changes.

‘Use the power of your voice – it shouldn't be the case, but our voices will be heard much louder than those who will be disadvantaged by this.’

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