Guest blog by Andrew McHugh, Medical Practice Director, Horsefair Surgery and Practice Manager Representative, Oxfordshire Clinical Commissioning Group.
Earlier this year the Department of Health issued a guideline that GPs should provide free healthcare to any overseas visitor requesting treatment. The guidance GPs have received was displayed on the NHS Choices Website. It read as follows:
If you need to see a doctor during your stay in the UK then you can register with a GP (general practitioner) practice as an NHS patient. You can register as a temporary patient with a GP practice when you are in the area for more than 24 hours and less than three months. It is up to the GP practice to decide whether to accept new patients or not. Treatment will be free of charge.
When these guidelines were published it produced a firestorm of e-mail traffic from GP practice managers in Buckinghamshire, Berkshire and Oxfordshire. In response to the concerns of my practice manager colleagues, I contacted my local MP, Sir Tony Baldry, to advise him of the concern the new guidelines had caused. I received a ministerial response informing me that the matter was being looked into but, other than that, not saying very much. I was, however, pleased to hear the Health Secretary, Jeremy Hunt, discuss the subject on Radio 4’s Today program on 3rd of July 2013…(http://www.bbc.co.uk/programmes/p01c7pst ). Later that day the following question was asked at Prime Minister’s Question Time .
Q14.  Dr Phillip Lee (Bracknell) (Con): As a doctor who once had to listen incredulously to a patient explain, via a translator, that she only discovered she was nine months’ pregnant on arrival at terminal 3 at Heathrow, I was pleased to hear the statement from the Secretary of State for Health today on health tourism. Does the Prime Minister agree that although the savings are modest, the principle matters? The health service should be national, not international.
The Prime Minister: My hon. Friend makes a very important point. This is a national health service, not an international health service. British families pay about £5,000 a year in taxes for our NHS. It is right to ensure that those people who do not have a right to use our NHS are properly charged for it…..
Source – Hansard
Despite all the rhetoric and hyperbole in the debate surrounding the question of health tourism, very little has changed apart from the tone of the NHS Choices website. The previous guidelines have been removed and had been replaced with the following text:
Non-UK residents will also be charged for hospital treatments. If you are an overseas visitor to the UK you may be charged for some treatments and, depending on how urgent it is, you will usually have to pay in advance….
The NHS is a residence-based healthcare system. If you are planning to live and work in England you’ll have to register with a general practitioner (GP). GPs are the first point of contact for nearly all NHS patients. They can direct you to other NHS services, and are experts in family medicine, preventative care, health education and treating people with multiple and long-term conditions.
You can also register as a temporary patient with a GP practice when you are in the area for more than 24 hours and less than three months. It is up to the GP practice to decide whether to accept new patients or not. Treatment will be free of charge.
I don’t have a problem with GPs providing a one-off GP consultation free of charge. The real problem, however, is that in order to register and treat overseas patients, GP practices will have to issue them with an NHS Number. Once the patient has an NHS Number they will, de facto, be eligible for NHS prescriptions, treatments and referrals. It becomes a lot easier for them to slip through the net to acquire free NHS hospital treatment.
I offer the following suggestion as to how screening for entitlement to free NHS treatment can be achieved without turning GP surgery staff into NHS Border Guards. The current NHS Number is in the format 999-999-9999. I propose that this format should only be available to patients currently registered with a UK GP surgery. When an overseas patient presents to register at a GP surgery, they will be asked where they are currently registered. If they are not currently registered with the UK surgery, they will be issued with an NHS Number in the following format X99-999-9999. This would indicate that the patient is not necessarily entitled to free treatment under the NHS.
Patients who are issued such an NHS Number would still be eligible for free GP consultations. However, any prescriptions, treatments or referrals recommended by the GP would have to be paid at the market rate, in advance, to pharmacies, treatment centres and hospitals. The onus would be on the patient to prove their entitlement. The GP surgery would have no role in either checking or policing the entitlement.
I fully accept that what, on the face of it, sounds like a simple idea would have significant logistical problems in implementation. One of the problems would be that current clinical systems are designed to recognise the NHS number in its existing format. This is not an insurmountable problem and should not be used as an excuse not to take this forward. In this time of austerity, I am in full agreement with the Prime Minister when he says
‘This is a national health service, not an international health service. … It is right to ensure that those people who do not have a right to use our NHS are properly charged for it.’
I think a different format of NHS Number for patients with an unclear entitlement to free treatment under the NHS would help, significantly, to stop health tourism.