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How to deal with patients from overseas

Dr Paul Mackin looks at the key considerations for practices when treating people from outside the UK.

People visiting the UK on holiday or to see relatives are not exempt from NHS charges (Photograph: Getty Images)
People visiting the UK on holiday or to see relatives are not exempt from NHS charges (Photograph: Getty Images)

Eligibility for free NHS treatment for overseas visitors has given rise to some confusion in recent years, and the government is currently considering further changes to the relevant legislation - the NHS (Charges to Overseas Visitors) Regulations 1989.

Although they also cover NHS hospitals, this is how these regulations relate to some of the key categories of overseas visitors when seen in GP practices and other primary care settings.

Key Points
  • Entitlement to free NHS care is usually determined by the 'ordinary residence' test.
  • Immediately necessary treatment must never be withheld for any reason.
  • Asylum seekers and victims of human trafficking are entitled to free NHS care.
  • GPs have discretion to register patients irrespective of their residency or immigration status.
  • In cases where there is doubt about providing treatment to overseas visitors, seek independent advice.

General considerations
Entitlement to free NHS care is based on the 'ordinary residence' test, which refers to anyone who has been living lawfully in the UK for 12 months immediately before receiving treatment.

Some treatment categories are currently free of charge, irrespective of the person's country of normal residence, and they include treatment for serious communicable diseases (such as tuberculosis), sexually transmitted infections and family planning services. Diagnosis and counselling (but not treatment) in relation to HIV infection is also exempt from payment.

Registering patients
Practices have discretion to register any patient, regardless of immigration or residency status. They are not obliged to confirm the immigration or residency status of any patient applying to join their list, and it is unlawful to act in a discriminatory way when considering a registration application from an overseas visitor.

If a practice refuses to register a patient, it must however notify the patient in writing within 14 days of the application and give reasons for the refusal.

Urgent treatment
With immediately necessary, urgent and non-urgent care treatment, doctors have an obligation to offer assistance in emergencies - see the GMC's Good Medical Practice. Immediately necessary treatment, including all maternity treatment, must never be withheld for any reason, and such treatment should be free.

Urgent treatment (defined as treatment which the clinician does not consider immediately necessary but which cannot wait until the person can reasonably be expected to return home), must also be given, although charges may be made where possible.

In deciding whether to offer non-urgent (routine or elective) treatment, you should assess how long the patient will remain in the UK, and treatment may be delayed until the full, estimated cost has been received.

Asylum seekers
People who have been granted refugee status, and those who have formally applied to the Home Office for asylum are entitled to free primary and secondary health care, and have the right to be registered with a GP practice.

Following a judicial review in 2008, the Court of Appeal found that failed asylum seekers cannot be regarded as ordinarily resident in the UK, and DoH advice was issued stating that failed asylum seekers are not exempt from NHS charges. Clinicians should not, however, withhold immediately necessary treatment for any reason.

Human trafficking victims
The Council of Europe Convention on Action Against Human Trafficking in Human Beings came into force in the UK in April 2009, resulting in a change to the NHS charging regulations. Anyone who the 'competent authorities' in the UK consider to be either a victim, or a suspected victim, of human trafficking must not be charged for NHS treatment. The competent authorities are the UK Human Trafficking Centre (UKHTC) and the UK Border Agency (UKBA).

Tourists and relatives
As people visiting the UK on holiday or to see relatives are not considered ordinarily resident in the UK, they are not exempt from NHS charges.

Visitors who ordinarily reside in a country with which the UK holds a bilateral healthcare agreement may be entitled to free NHS treatment that is needed promptly for a condition arising after arriving in the UK.

Exemption from NHS charges does not normally extend to relatives of UK residents.

Students
People pursuing a full-time course of study in the UK lasting at least six months, or a course of study of any duration which is substantially funded by the UK government, are exempt from NHS charges. This exemption also extends to the student's spouse, civil partner and children if they are residing permanently with the student during their period of study.

Students studying for less than six months on a course which is not substantially funded by the UK government are liable for NHS charges.

NHS statutory charges
Regardless of the exemptions categories above, overseas visitors may still be required to pay NHS statutory charges.

See www.nhsbsa.nhs.uk/HealthCosts for more information. If you are unclear about your responsibilities for providing care for overseas visitors, you can consult DoH guidance at www.dh.gov.uk.

CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Hold a practice meeting and ensure all staff are aware of who is eligible for treatment, and to be patients.
  • Review any processes relating to treating patients from overseas.
  • Ensure that your practice website and brochures contain the relevant and correct information in relation to overseas visitors.
  • Also consider whether you have information available in a sufficient range of languages, so that you can help overseas visitors understand the eligibility, rules, or where they can seek further information.

Save this article and add notes with your free online CPD organiser at gponline.com/cpd


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