Migrant health: Trusts asked GPs to identify whether patients they refer are eligible for free NHS care

Hospital managers who are responsible for charging overseas patients for NHS treatment asked some general practices to help them identify whether patients were eligible for free care, the BMA has said.1

The BMA’s General Practitioners Committee warned GPs in a newsletter that overseas visitor managers had written to some London practices and asked them to note on referral letters those patients who were regarded as “overseas visitors” because they had been a UK resident for less than six months.

Both the GPC and Londonwide Local Medical Committees have told GPs that this was not their responsibility, as set out in government guidance.

The relationship between the government and GPs in regards to patients’ immigration status has been strained for years.

In 2015 the BMA called for UK doctors to refuse to check the immigration status of patients seeking healthcare, after a motion was passed at the annual representative meeting saying, “NHS staff do not have any role in policing immigration.”2 And last year doctors and nurses protested against the Home Office’s use of NHS services and staff to help with immigration enforcement.3

The GPC’s newsletter (dated 4 October) said that it wanted “to reassure practices that this is not their responsibility” to check patients’ status and that “they are not required to do so.” It said that guidance of the Department of Health and Social Care for England was “clear that the responsibility for determining a patient’s eligibility for NHS care lies with the trust and never with a GP or GP practice.”

It also asked GPs to make it clear to prospective patients that questions regarding a patient’s eligibility for free care on the GMS1 form (which is used to register patients permanently with a general practice) did not have to be completed before a patient could register.

GPs who have been approached by hospitals’ overseas visitor managers with similar requests should contact the BMA, it advised.

Michelle Drage, chief executive officer of Londonwide Local Medical Committees, said, “It is important that GPs make referrals based on clinical judgment and need, rather than perceived eligibility. According to NHS regulations, everyone is entitled to free access to primary care services, including general practice.”

The health department defines an “overseas visitor” as any person who is not “ordinarily resident” in the UK. A person will be “ordinarily resident” when their residence is “lawful, adopted voluntary, and for settled purposes as part of the regular order of their life for the time being, whether of short or long duration.”4The BMJ asked the department to clarify this, but it had not replied by the time of publication.

Charges are exempted for vulnerable patients, who have access to the NHS in the same way as patients who are ordinarily resident. These include people who have been granted asylum, those with an outstanding asylum claim or appeal, victims or suspected victims of modern slavery, unaccompanied children under the care of local authorities, and people being held in immigration detention.5