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Coping with a 2012 visitor influx

Expect an influx of visitors for the Olympics and Queen's Diamond Jubilee.

The UK is preparing itself for a massive influx of visitors for the Olympics and the Queen’s Diamond Jubilee. Should your practice get ready? (Photograph: Alamy)
The UK is preparing itself for a massive influx of visitors for the Olympics and the Queen’s Diamond Jubilee. Should your practice get ready? (Photograph: Alamy)

Summer 2012 is predicted to be a bumper year for visitors to the UK in addition to the usual steady flow of tourists.

Practices in all areas, but especially those close to Olympic venues in the London area, will want to ensure they are aware of the administrative and financial consequences of this potential extra work.

Olympic facilities
It is unlikely that any practice will be asked to treat Kenyan marathon runners' or Canadian cyclists' strained muscles, because there will be experienced sports physicians travelling with the visiting teams. There will, however, be a huge number of other visitors to the London Olympics.

Apparently there will be more members of the press attending than athletes, but they will usually be cared for by specific Olympic centres for administrators and the media.

GPs also need to be ready to treat patients who visit for the Queen's Diamond Jubilee.

The majority of visitors - whether spectators from the UK or further afield - will present with familiar problems: UTIs, chest infections, ankle sprains, mislaid medicines and so on.

Visitor categories
There are three categories: UK residents, those from countries with reciprocal health service arrangements and visitors from further afield.

The 2004 GMS contract has simplified GPs' previous problems of defining and claiming for specific patients travelling within the UK depending on how long they are staying in the area. Funding for temporary residents and for providing immediately necessary treatment is now included in the global sum for GMS practices and in the PMS baseline.

These days, the forms completed for UK patients you treat while they are visiting your area allow information to be fed back to their usual practice.

One difficulty can arise with UK citizens, mainly expatriates, who are not 'ordinarily resident' here. If such patients are not resident, then they are probably not covered by the NHS and may need to be treated as private patients.

GPs should ensure that their practices provide receipts for fees paid to allow these patients to claim some of their treatment costs from the travel insurance that they should have purchased.

Countries where there is no reciprocal arrangement - generally outside Europe and the Commonwealth - are not entitled to NHS treatment. They should be treated as private patients and consequently, may be charged appropriately.

Reciprocal arrangements
Over the years, one of the biggest problems relating to visitors from countries with reciprocal arrangements is dealing with requests for urgent or immediate medical treatment.

This can produce uncertainty as to how urgent the problem really is. For example, forgetting their usual medication when coming to the UK may be deemed non-urgent but the consequences of not taking it may precipitate an urgent problem.

To overcome such issues, my practice now treats patients not normally resident in the UK as private patients except in a very small number of cases. If foreign visitors feel that they should be entitled to free NHS treatment, our reception staff direct them to the local NHS walk-in clinic or A&E.

We have experienced few problems as a result of applying this policy and patients have the possibility of claiming against their travel insurance for all or part of the expense incurred.

2012 DATES

Queen's Diamond Jubilee
Main events 2 to 5 June.
www.culture.gov.uk


London 2012

  • Olympic Games 27 July to 12 August
  • Paralympic Games 29 August to 9 September

www.london2012.com

Charging fees
Private fees vary between practices and in 1994 the Monopolies Commission stopped the BMA and any other organisations recommending fee levels. Practices should devise their own system and it is a good idea to publicise fees on the practice website and/or on a prominent waiting room notice.

Most practices charge for a consultation and then a pro rata fee beyond this for any more complicated and time consuming work. While it might be tempting to charge a premium rate, the GMC advises that such charges should be clear and that advantage should not be taken of a vulnerable individual.

Dispensing privately
Ours is a dispensing practice and a large number of our consultations with visitors conclude with issuing a prescription, whether for a regular medication left at home or for treating an acute condition.

With visitors, the usual restrictions on who you can dispense to do not apply. If the patient is entitled to NHS treatment you can then issue a normal prescription and dispense it from the practice, no matter how close to a pharmacy the visitor is staying. Similarly if the individual is being treated as a private patient, NHS regulations do not apply and again, all patients may be dispensed to directly by the practice.

Most practices charge a fee for dispensing a private prescription, usually a percentage of the cost of the medicine along with any required VAT and the original drug price, with a minimum fee equal to the cost of an NHS prescription (currently £7.40 in England).

It is possible to dispense controlled drugs to a patient privately but this always concerns me. I prefer to register the patient as an NHS temporary resident and write an NHS prescription.

Planning ahead
The degree of planning ahead required for dealing with visitors to the UK next summer will depend largely on the likelihood of there being an influx in your area, which in turn will depend on the location of the practice and its proximity to an Olympic venue or to Diamond Jubilee events. Check if anything will take place in your area (www.london2012.com and www.culture.gov.uk).

Setting aside consultation slots in advance to cope with visitor 'peaks' is worth considering. Or at least build in some flexibility to your appointment system for the Olympic fortnight. Practices close to Olympic venues may wish to pre-book locum help or reduce the numbers of clinicians on holiday during the games.

As ever, the most important aspect of planning ahead is to ensure those on the front desk are aware of the practice's policy on treating visitors.

  • Dr Phipps is a GP in Lincolnshire

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