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British Medical Association finds NHS overseas charging regulations deter vulnerable groups from accessing treatment


BMA says urgent action needed, including a full and independent review

Date of Publication:
01 May 2019

British Medical Association finds NHS overseas charging regulations deter vulnerable groups from accessing treatment

01 May 2019

The British Medical Association (BMA) last month released a short new report on the impact of NHS overseas charging regulations on patients and the doctors who care for them. You can download the report here.

Charges to use the NHS were introduced for temporary migrants in 2015. The charges were further expanded in 2017, including the introduction of upfront charging for non-urgent care.

The BMA finds in its new report that there "is now clear evidence that The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 are deterring vulnerable groups from accessing NHS treatment, threatening public health, and taking vital clinical time away from patient care."

Upfront charging was found to have a deterrent effect.

Of the BMA members who were surveyed for the report, 35% answered that ineligible patients or those unsure of their chargeable status are being deterred from accessing care because of upfront charging, while only 24% felt that they are not.

The report stated: "Respondents commented that asylum seekers would be deterred and may feel more vulnerable. Others cited specific examples from their experience, including inappropriate use of emergency departments and delayed presentation to services. A number of respondents also reported blockages in onward referral to specialist care and pressure on primary care due to managing patients or issues that should properly be treated in secondary care. Negative impacts on UK residents who are eligible for free NHS care were also highlighted, including being deterred from accessing care after being inappropriately charged and instances of stress-related illnesses in those caring for and financially supporting overseas visitor relatives with health issues."

BMA members were asked about the impact the NHS charges would have on vulnerable groups. 70% of those who responded said they felt the regulations would have an overall negative impact, with over 25% of respondents answering that the impact would be significantly negative. Only around 2% felt that the impact would be positive.

The BMA also found that many doctors have faced pressure from NHS Overseas Visitors Managers (OVMs) when making clinical judgements regarding a patient's need for care.

The BMA concludes that the NHS overseas charging regulations have had, and continue to have, a negative impact on patient care and public health, and urgent action is needed to address these issues, including a full and independent review into the impact of the regulations.

While the BMA recognises that in certain cases it may be appropriate to charge overseas visitors for the use of some NHS services, it says it is vital that the system does not deter patients or prioritise administrative process over the medical needs of patients.

The report states: "It is our strong and longstanding view that existing overseas charging regulations fail to meet these criteria and, moreover, have had a negative impact on both NHS staff and patients, including the most vulnerable. The findings of our survey strongly reinforce these concerns.

"Our research indicates that the introduction of up-front charging has had a profound deterrent effect on patients, driving many to avoid seeking care altogether, including care they are entitled to or which remains free of charge. The experiences of our members illustrate that in many cases the regulations are also discouraging patients, particularly those from vulnerable groups, from accessing care until their conditions have worsened significantly."

Dr John Chisholm, BMA medical ethics committee chair, said: "The role of doctors – and all of their healthcare colleagues – must be to treat and care for patients, not to act as border guards, policing patients' access to and payment for treatment … The Government must now take urgent action and come clean over the evidence they have on the impact these rules are having on the ground. The public has a right to know what the evidence shows."

In response to the BMA report, a spokesperson for the Department of Health and Social Care told the Guardian: "British taxpayers support the NHS, and it is only right that overseas visitors also make a contribution to our health service, with the money recovered being reinvested back into frontline services so everyone receives urgent care when they need it.

"Patients must always receive urgent treatment regardless of whether they can pay, hospitals never charge for A&E care or for patients with infectious diseases, and exemptions are in place for the most vulnerable, including asylum seekers."