Access to Primary Medical Services for Overseas Visitors
An overseas visitor is defined as a person not ordinarily resident in the UK. This is a short term circumstance, which lasts until the person either returns abroad or becomes resident in the UK on a legal settled basis.
Practices may accept onto their list of patients anyone who applies. They may also refuse to accept people as patients but only if there are reasonable and non-discriminatory grounds for doing so that do not relate to the applicant’s race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.
So in practice, GPs’ discretion to refuse a patient is limited. Examples of where a GP can refuse to register a patient would be if the patient was violent, lived outside the practice area or if the practice was closed to any new patient registration.
Overseas visitors, whether lawfully in the UK or not, are eligible to register with a GP practice even if those visitors are not eligible for secondary care services.
Treatment can be provided to overseas visitors as follows:
- Registration with a practice
A person may register with a practice as a permanent patient or be accepted as a temporary resident. A person is a temporary resident if they live in an area for more than 24 hours but not more than three months.A person who is accepted onto a practice’s list of patients is entitled to free NHS primary medical services.
- Alternatives to registration
A person who has not been accepted onto a GP practice list, or accepted as a temporary resident, can still be treated by a GP practice.
A practice is required to offer free NHS treatment to anyone who requests it if, in the opinion of a healthcare professional, it is immediately necessary.
Immediately necessary treatment includes treatment, in the clinical judgement of a healthcare professional, of a pre-existing condition that has become exacerbated during a person’s stay in the UK
A practice is also required to offer free-of-charge emergency or immediately
necessary treatment to a person who
– has been refused acceptance for inclusion on the practice’s list of patients for up to 14 days from the date of refusal or until registered elsewhere – whichever is sooner
– the practice has refused to accept as a temporary resident for up to 14 days from the date of refusal or until accepted elsewhere – whichever is sooner
– Is in an area for less than 24 hours up to 24 hours.
Also, individuals can still be seen on a private basis, for which they would also be charged.
Past or present payment of taxes or national insurance contributions is not taken into account when establishing eligibility for overseas visitors to receive free NHS treatment.
Requesting information from patients
In applying to become a patient there is no formal requirement to prove identity or immigration status. However, there are practical reasons why a practice might need to be assured that they are who they say they are – so it can help the process if a patient offers relevant documents. Many asylum seekers offer to show their Immigration Service-issued application registration card (ARC) or other official documents that confirm their status.
Any practice that requests documentation regarding a patient’s identity or immigration status must do so in a non-discriminatory way for every patient. Any inconsistent application of policy could lead to legal action.
Some patients may legitimately be unable to produce any of the listed documentation to prove residency or identification. Registration and appointments should not be withheld because a patient does not have the necessary proof of residence or personal identification.
Also, reasonable exceptions should be considered. If a patient cannot produce the listed documentation but states that they reside within the practice boundary then practices could either:
- Accept the registration but with a note for them to bring documentation next time they attend the surgery
- Provide the patient with time to produce documentation by registering them as a temporary patient with a view to conversion to regular patient status later
- Agree to register them as a NHS patient on the basis of information provided by other household members who do have the necessary documentation.
If a practice suspects a patient of fraud (such as fake or multiple ID) then they should register and treat the patient but hand the matter over to their local counter-fraud specialist.
Other NHS services
While acceptance of a patient onto a GP practice’s list of patients allows access to primary medical services, it does not automatically entitle an individual to receive other NHS services free of charge. For example, a patient may require necessary drugs and dressings. These are supplied and prescribed in the same way as for UK residents and prescription charges might also be applicable.
Equally, being registered with a GP, or having a NHS number, does not give a person automatic entitlement to access free NHS hospital treatment even if they are referred to hospital by their GP. It is the relevant NHS body’s duty, not the GP’s, to establish entitlement for free hospital treatment. Furthermore, neither relevant NHS bodies, nor anyone acting on their behalf, should imply that a particular patient should not be registered with a GP practice, as that is exclusively a matter for the GP.
Certain overseas visitors are entitled to free hospital services but others are not. Information regarding overseas visitors’ access to hospital treatment and where exemptions apply are contained within the NHS (Charges to Overseas Visitors) Regulations 2011.
All of the above information is applicable to illegal immigrants.
Asylum seekers and refugees
Asylum seekers and refugees are entitled to register with a GP practice. They are able to access both primary and secondary care without charge. As above they have to pay certain statutory NHS charges (eg prescription charges) unless they also qualify for exemption from these.
GP practices have the discretion to accept failed asylum seekers as registered NHS patients although such patients are not eligible for free hospital treatment.
On 18 March 2011 the government announced a further review regarding charging foreign nationals for NHS services, which it stated would include whether GP services and other NHS services outside of hospitals should be charged for. The review is expected during 2012.
Table of Entitlement to NHS Treatment (April 2009)
The National Health Service (Charges to Overseas Visitors) Regulations 2011
NHS charges for overseas visitors – parliamentary briefing