GP primary care services are not included in overseas visitor charging regulations, but with increased publicity, debate and recent rule changes over NHS charging, confusion can arise.
Whilst there may be charges for some overseas patients in secondary care, even people who are in the country illegally are likely to be entitled to free GP services and nurse consultations in primary care.
This premise has been maintained despite numerous reviews and consultations due, not in small part, to a sense that maintaining free access to GPs for all is in the best interests of public health, especially in terms of preventing the spread of communicable disease.
Additional confusion may arise due to variations in legislation between England, Northern Ireland, Scotland and Wales.
NHS entitlement for non-residents
In England, treatment in Accident and Emergency departments and at GP surgeries is free for all, including non-UK residents.
This position was reinforced by Government charging reviews and consultations in 2012, 2013 and 2015.
Sustaining services, ensuring fairness: Government response to the consultation on migrant access and financial contribution to NHS provision in England made plain that people in the UK illegally or on temporary visitor visas were included in this and do not have to pay for GP services.
Even where a patient is refused registration with a GP practice for appropriate non-discriminatory reasons, any immediately necessary treatment must be provided free of charge for up to 14 days.
A broadly similar framework is in place across the UK currently in terms of charging overseas patients, but as it is a devolved matter, variations may exist in Scotland, Wales and Northern Ireland. It is important to be aware of the localised regulations.
Rules around registering non-resident patients for GP services
Department for Health and Social Care guidance on implementation of charging regulations states, that anyone in England can register as an NHS patient and consult with a GP, non-residents included.
There have been cases where GP surgery staff have not fully understood this, and their responsibilities in regard to ensuring people are not blocked from registering based on not having a residential UK address.
There is no minimum threshold on the amount of time someone has to have been in the UK before they register with a GP.
GPs cannot refuse to register patients on the grounds of race, religion, appearance, gender, sexual orientation or medical condition.
NHS guidance states that a patient cannot be refused due to not having identification or proof of address. This is to protect recent migrants and vulnerable patients including asylum seekers, refugees, overseas visitors and the homeless.
GP responsibilities in relation to identifying chargeable patients
GPs in England must provide new patients with the revised GMS1 registration form, which includes a section for patients to provide information to help determine eligibility for free NHS secondary healthcare.
However, it is not the responsibility of GP practices to identify chargeable patients. It is down to the body providing chargeable NHS services to establish eligibility.
Hospital Overseas Visitor Managers are advised to seek to establish contacts with GPs to help them fulfil their obligation to identify chargeable patients, but confidentiality responsibilities do need to be maintained by GP practices.
All personal information shared by a patient with their GP is confidential, including demographic data. Doctor-patient confidentiality should be closely protected in relation to all information shared. Generally, consent should be sought to share information where appropriate, and it should usually only be shared without consent where there are exceptional and justifiable circumstances, such as the prevention of serious harm or in detection of serious crime.
GPs should not make judgements over eligibility for secondary care, and should refer wherever clinical grounds demand it. Even if a previous referral has led to a conclusion that a patient is not eligible for free care, new referrals should be made in the same way as usual – circumstances may have changed or need may have become urgent.
GPs may wish to advise patients that a referral does not mean they will be entitled to free secondary care. Displaying posters regarding NHS entitlement may be advisable.
The requirements and rules in relation to registering patients and identifying chargeable patients are not standardised across the UK, and it is necessary to be aware of country specific legislation.
Mistakes in interpretations of rules and requirements in terms of registering overseas patients, approving them for treatment and information sharing can all lead to negative outcomes for patients and practices. It is vital to have a grip of rules and for staff training to remain updated.
Legal advice is available 24/7 to MDS members.