Government’s migrant charging proposals impractical, uneconomic and could damage the NHS, warns BMA

The government’s proposals for an extended charging system for migrants and short term visitors attempting to access healthcare in UK are impractical, inefficient, uneconomic and could cause unintended damage to NHS services, the BMA said today (Wednesday, 28 August 2013)

Responding to the government’s recent consultations on migrant and short term visitor access to the NHS, the BMA has outlined serious concerns about these proposals:

There is no evidence that the income derived from charging short term visitors or migrants would be sufficient to cover the significant cost of the increased bureaucracy necessary to administer the system.
It is difficult to see how extending charging to general practice could be implemented without ensuring every patient was checked by their GP practice when they register, resulting in inconvenience for all patients and an increased administrative burden on already over stretched GP services.
There is no explanation of what documentation patients will need to use to prove they have permanent residency. There is no obligation for UK residents to hold a passport and the documentation some practices currently require, such as utility bills, would not prove permanent resident status.
Forcing non-European Economic Area (EEA) migrants2, and any dependents, to make a contribution to their healthcare costs could reduce the likelihood of highly skilled migrants coming to work in the UK.
If migrants and short term visitors are deterred from seeing a GP, it may become more difficult for the NHS to identify communicable diseases such as TB. This could increase public health risks for the wider population and result in increased stress on NHS services.

The BMA agrees with the government that care should not be denied to patients who require immediate treatment, but the current proposals do raise ethical concerns. For example, charging could deter patients from seeking emergency care and could make them reluctant to bring their children to a GP practice or emergency care department.

Dr Mark Porter, Chair of BMA Council said:

“The BMA believes that anyone accessing NHS services should be eligible to do so, but the government’s plans for extending charging to migrants and short term visitors are impractical, uneconomic and inefficient. The NHS does not have the infrastructure or resources to administrate a charging system that is not likely to produce enough revenue to cover the cost of setting up its own bureaucracy. The NHS does not need more administrators; it should be spending its money on caring for patients.

“More worryingly, the proposals could have an impact on the care all patients receive. If non-EEA doctors are forced to make contributions to their healthcare this could discourage them from coming to practice in the UK and working in key services, such as emergency departments, which are experiencing doctor shortages. This could exacerbate the current workload pressures already facing the NHS.

“The government needs to rethink it is entire approach to this issue as in their current form these proposals are unworkable and potentially damaging to the NHS.”

Dr Chaand Nagpaul, Chair of the BMA’s GP committee said:

“GPs, like many other NHS staff, do not have the capacity to administer a complicated bureaucratic system that is of questionable benefit to taxpayers and patients.

“Asking patients to produce documentation to prove their residency faces a number of problems. It would mean all patients would have to have their eligibility checked each time they register with their GP. This would be a huge inconvenience to all members of the public and would take up valuable time that practices could be using to treat patients. Some UK residents, especially many older people, will not have a passport or a bank account which raises the concern that some of the most vulnerable members of our society will face delays in accessing care.

“We have seen with the recent NHS 111 debacle what happens when an ill thought out policy is rushed through without proper consideration of the practical and clinical implications. Ministers need to learn from recent experiences and work with healthcare professionals to find workable solutions to this issue.“

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