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10 August 2017
The rules governing treating overseas visitors from outside the EU have been amended
Overseas visitors are exempt from charges for accessing primary care services, and GPs are not expected to establish entitlement for free NHS hospital treatment. But practices are encouraged to work with overseas visitor managers in NHS bodies to ensure relevant patients are informed about entitlement to NHS hospital treatment, as explained below.
The National Health Service (Charges to Overseas Visitors) Regulations 2015 have been amended, with effect from 21 August 2017. The charges apply mainly to patients from outside the European Economic Area, treated in hospitals in England. Wales, Scotland and Northern Ireland have their own legislation and guidance.
There have been some changes to eligibility criteria, types of NHS care covered, and the obligations on NHS bodies. The Department of Health has also produced new guidance primarily aimed at staff within NHS trusts. It recommends that all NHS bodies appoint an Overseas Visitor Manager (OVM) whose responsibilities will include ensuring that local GPs are aware of the main provisions of the regulations.
The regulations surrounding entitlement are complex. NHS care is provided free on the basis of an individual being 'ordinarily resident' in the UK. Issues such as nationality, payment of taxes or national insurance contributions, or having an NHS number are irrelevant. In fact, a UK national living overseas might not be eligible for free NHS care.
Other individuals entitled to free NHS care include EEA nationals insured for healthcare by a member state, those from countries with reciprocal healthcare arrangements with the UK, refugees, asylum seekers, prisoners and immigration detainees.
The regulations require NHS Trusts, private providers of secondary or community care, and local authorities to establish whether a person is an overseas visitor to whom charges apply, or exempt, and then to recover the charges.
Non-exempt overseas visitors must pay up front for any care not deemed by a clinician to be immediately necessary or urgent.
The charges apply to most non-emergency hospital care and treatment. Primary care, A&E treatment, family planning and palliative care services provided by a registered charity or community interest company are all exempt from the regulations. Treatment under the Mental Health Act is also exempt, as are diagnosis and treatment of sexually transmitted diseases, and certain other infectious diseases such as TB.
GPs have discretion to accept any overseas visitors as a registered NHS patient, or as a temporary resident if they are to be in an area for between 24 hours and three months. No registration application can be refused on the grounds of race, gender, class, age, religion, sexual orientation, appearance, diversity or medical condition. In reality, this means that the practice’s discretion to refuse a patient is limited. Furthermore, GPs have a contractual and ethical duty to provide immediately necessary treatment, regardless of whether that person is an overseas visitor or registered with that practice.
There is no obligation on GPs to ascertain the entitlement status of overseas visitors, and it would be unlawful to perform any checks that would not be routine for any other person applying to join the list.
The guidance emphasises that GPs should not be discouraged from referring their patients to the relevant NHS body, nor is it the GP's duty to establish entitlement for free NHS hospital treatment. However it encourages OVMs to establish formal contacts with local GP surgeries and suggests that practices can help by:
When there is a suspicion that an overseas visitor is attempting to access, or has accessed, free NHS treatment by fraud or deception, you should consider reporting this to the relevant body’s Local Counter Fraud Specialist. You should consider your duty of confidentiality, whether the patient had consented to disclosure, and whether disclosure without consent could be justified in the public interest, in accordance with GMC guidance.
Changes to the GP contract have been agreed for 2017-18 that help to identify overseas patients’ status with respect to the Charging Regulations. From a date in 2017 (yet to be decided), practices will be required to provide all new patients with a revised GMS1 form (used to register patients permanently with a GP practice), which includes supplementary questions to determine a patient’s eligibility to free hospital healthcare. For those patients who self-declare they hold either a non-UK issued EHIC or a S1 form, the practice will be required to manually record that the patient holds either of these forms in the patient’s medical record and then send the form and supplementary questions to NHS Digital (for non-UK issued EHICs) or the Overseas Healthcare Team (for S1 forms) via email or post. More information will be provided in due course.
We have previously received calls from members with queries about patients' entitlement for treatment. Doctors with specific concerns should contact our advice line on 0800 716 646 or their local OVM.
Dr Beverley Ward
Beverley is a former GP and has been a medico-legal adviser at the MDU since 2008. She provides advice and assistance to members of all specialties on ethical and legal matters arising from their care of patients.
This guidance was correct at publication 10/08/2017. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
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