Immigrants and overseas visitors are to be charged for using A&E in England

BMJ 2013; 347 doi: (Published 31 December 2013) Cite this as: BMJ 2013;347:f7698
  1. Zosia Kmietowicz
  1. 1BMJ

Immigrants and temporary visitors to England will not be charged to see a GP but will have to pay for using hospital accident and emergency services and some primary care services, the government has said in what it calls a clampdown on misuse of the NHS.

No one will be turned away in an emergency, the Department of Health has said. And it will introduce a new system for identifying and recording patients who should be charged for NHS services.

Non-UK residents will also be charged for maternity services and prescriptions and will be charged at a higher rate for services that are subsidised, such as optical and dental care. The health department is also considering charging for minor surgery carried out by a GP and for physiotherapy that has been referred through a GP.

Research published by the government in October found that the cost of treating migrants and visitors could be as high as £2bn (€2.4bn; $3.3bn) and that the NHS in England could save up to £500m a year if overseas visitors and immigrants paid for NHS healthcare.1 However, the BMA and the researchers themselves questioned many of the assumptions on which the calculations were based.

Further detail on the timing of implementation of the new plans will be available in March 2014, said the health department, but many changes will start to be introduced over the coming year.

Although the current rules state that visitors must pay for any services they receive, the existing system fails to identify them and recover the costs, the department said. It said that some women abused the system by coming into the country early enough to have one or more antenatal appointments before giving birth on the NHS, without intending to pay. Others were unable or unwilling to pay for the costs they incurred, it said.

In other cases, family members of UK residents came to the United Kingdom, registered with a GP, and then received NHS drugs and hospital care. Some people on visitor visas came to the UK to seek immediate treatment, including maternity services, the department said.

Under separate moves to reduce “health tourism” the Home Office is introducing new charges for people who live in the UK but who don’t have permanent residency. Under the new immigration bill announced in October, temporary migrants from outside the European Economic Area, such as students, would have to pay a surcharge to access free NHS care. A figure of £200 has been mentioned.2

The BMA and the Royal College of General Practitioners have previously warned that the plans to tighten access to the NHS could see GPs becoming a form of immigration control.1 3 They also raised concerns about the potential risks to public health if patients were deterred from seeking treatment when they needed it, which could lead to them requiring more expensive emergency treatment if their condition deteriorated.

The plans’ proposal to make initial access to GP and nurse consultations free was a direct response to these public health concerns, said the health department.

Announcing the latest plans for England the health minister Lord Howe said, “Having a universal health service free at the point of use rightly makes us the envy of the world, but we must make sure the system is fair to the hardworking British taxpayers who fund it.

“We know that we need to make changes across the NHS to better identify and charge visitors and migrants. Introducing charging at primary care is the first step to achieving this.”

The BMA said that the latest plans could lead to confusion and increased bureaucracy, as some services would remain free while others are chargeable. GPs and hospital doctors would be required to regulate the charges, which could mean that the new system would cost more to run than it collected in revenue.

Mark Porter, the BMA’s chairman of council, said, “There remains a real risk that some migrants and short term visitors who desperately need care could be discouraged from approaching the NHS if they cannot pay the proposed charges. There is particular confusion over access entitlements to emergency care services, given the proposals introduce charging for A&E visits yet say no patient will be turned away if they need care.”

Chaand Nagpaul, chairman of the BMA’s General Practitioners Committee, said that the plans “could introduce another layer of time consuming bureaucracy to general practice at a time when GPs and their staff are struggling to cope with rising workload and patient demand.”

He added, “GPs should be spending their time treating patients and not filling in forms for a complicated charging system that may not in the long term save large amounts of money.”


Cite this as: BMJ 2013;347:f7698