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Thanks to the authors for outlining their concerns about the potential effect of the proposals for upfront charges for overseas NHS patients, which I fully agree with. The measures are unlikely to reduce spend significantly but have the potential to increase anxiety and conflict within the medical profession and are likely to also disadvantage all patients through the bureaucracy of implementation and potentially lead to the denial of treatment to some of the most vulnerable in our society. It is particularly unpleasant that the restriction to entitlement should be extended to children. I support the suggestion that the proposals should be withdrawn pending a robust impact assessment of wider social factors.