Intended for healthcare professionals


Upfront charging of overseas visitors using the NHS

BMJ 2017; 359 doi: (Published 18 October 2017) Cite this as: BMJ 2017;359:j4713
  1. Lucinda Hiam, health adviser1,
  2. Martin McKee, professor of European public health2
  1. 1Doctors of the World, London, UK
  2. 2London School of Hygiene and Tropical Medicine London WC1H 9SH
  1. Correspondence to: M McKee martin.mckee{at}

Changes are a threat to everyone

When asked what makes them proud to be British, more people cite the NHS than anything else, ahead of British history, sense of humour, and the monarchy.1 Its popularity transcends all ages and political allegiances.2

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 pay3—were restated as recently as 2011, when a “wider social duty to promote equality” was added. The intention was not that everyone in the UK would be entitled to care; entitlement is based on lawful residence. However, even those not entitled to free care would be given it, with healthcare providers seeking to recoup the costs later. Health professionals could therefore concentrate on the tasks of diagnosis and treatment. This is no longer the case. From 23 October 2017, anyone, including children, attending healthcare facilities in England who is unable to establish their entitlement to free care will be charged upfront for the estimated cost of treatment.4 If they are unable to pay, treatment may be refused.

Healthcare teams face two challenges.4 Firstly, they must establish whether the patient is entitled to …

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