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What are the rules on treating overseas patients (Including Refugees and Asylum Seekers)
Do I have to treat a patient who lives overseas or is not a British citizen?
Yes – anyone in England, regardless of nationality and residential status, is eligible to register and consult with a GP This includes all overseas visitors, asylum seekers and refugees, students, and people on work visas, irrespective of immigration status.
Can I charge?
Practices are not permitted to charge overseas patients – including tourists – for registering or consulting with a GP.
What is the indemnity situation with overseas patients? Is it different?
This will be covered under the Clinical Negligence Scheme for General Practice (CNSGP)
How is the situation for GP practices different from the situation for hospital care?
Whereas all overseas patients are entitled to receive NHS primary care at a GP practice only certain patients have a right to free secondary care. NHS England guidelines advise GPs to refer patients for secondary services on clinical grounds alone; it is the receiving organisation, not the GP, who is to assess a patient’s eligibility for free secondary care.
Should I register a patient as temporary or permanent?
A patient should be registered as temporary if they intend to be resident in the practice area for more than 24 hours but fewer than three months. If the patient intends to reside in the practice area for longer than three months, they should be registered as permanent.
Do I need to ask for proof of address?
Practices are not contractually obliged to ask for proof of address. While practices may ask for proof of address for practical reasons, a patient’s inability to provide this would not be a sufficient reason to refuse their registration.
So, if a patient claims to reside within the practice area but is unable to prove this, the practice must register the patient in the absence of evidence to the contrary.
What if they live outside my boundary?
If there is evidence that a patient lives outside of the practice boundary, GP practices are permitted to register them under the government’s ‘patient choice’ scheme. However, they are not obliged to do so.
Do I need to ask for the patient’s ID at registration?
Practices are not required to ask for the patients ID upon registration. However, practices can choose to implement a policy whereby they ask for patient ID as part of the registration process. Such a policy must explain the procedure in place for patients who are unable to supply identification, and any such policy must apply to all prospective patients equally. Where patients are unable to provide ID this shouldn't affect whether you register a patient.
Can I decline to register a patient?
GPs have limited discretion to decline to register patients. A GP can only refuse to register a patient if their list is closed to new patients, if the patient lives outside the practice boundary, or if other reasonable grounds for the refusal exist.
In the event that a practice does refuse a patient’s application, NHS England states that the practice is obliged to record the name, date and reason for the refusal. The practice must give the patient a written explanation of the refusal within 14 days.
Is deciding not to register a patient purely because of their status as an overseas visitor discriminatory?
Yes – all applications for registration must be considered in the same way. The prospective patient’s country of residence is irrelevant to the application process.
Refugees and Asylum Seekers registering at your practice
These patients should be routinely vaccinated as per the incomplete immunisation schedule using the age appropriate algorithm (which includes adults). https://www.gov.uk/government/publications/vaccination-of-individuals-with-uncertain-or-incomplete-immunisation-status
There is some general health information in the link below:
Vaccines to consider:
- measles (using MMR vaccine and prioritising children up to 15 years)
- poliomyelitis (for children and adults coming from countries currently exporting poliovirus such as Afghanistan and Pakistan, infected countries such as Somalia, or countries which remain vulnerable to international spread, including Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, and the Syrian Arab Republic)
- meningococcal disease (preferably with vaccines against meningococcal serogroups A, C, W-135 and Y
- diphtheria (using diphtheria-tetanus-pertussis vaccine in accordance with national guidelines)
- influenza, according to the season.
Consider screening for infestation with lice. Screening for tuberculosis can be considered in accordance with national guidelines. http://ecdc.europa.eu/en/publications/Publications/refugee-migrant-health-in-european-winter-rapid-risk-assessment.pdf
Consider Vitamin D deficiency https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d
What if I suspect a patient of fraud?
If there is a suspicion that a patient is committing fraud, by using a fake address for example to try to obtain treatment, GPs ought nevertheless to register and treat the patient. However, GPs must refer the matter to their local NHS counter-fraud specialist or report the matter at www.reportnhsfraud.nhs.uk