Department of Health provides assurance that migrants will not be pursued for GP service costs

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The Parliamentary Under Secretary for Public Health, Anne Milton, has written to MRN to provide assurance that migrants and visitors who consult GPs or use other primary health care services whilst in the UK will not be pursued by the UKBA to pay costs or lose the right to re-enter the country.

The issue had become a matter of concern for GPs and primary care trusts because recent immigration rule changes created a power for immigration officers to refuse entry to any person with an unpaid debt to the NHS of £1000 or over.

The reason behind this measure is set out in UKBA internal guidance note to its officers, stating that:

An ongoing objective for the UK Border Agency is to help protect the UK’s publicly funded services and to prevent their misuse by those who are not entitled to free access.

The guidance goes on to say that:

It is intended that people subject to immigration control who fail to clear outstanding National Health Service (NHS) charges of or above £1,000 should be refused permission to re-enter or extend their stay in the UK, and the NHS should share information about relevant non-payers with the UK Border Agency so that individuals can be identified for action when they come into contact with the immigration system.

This policy has been criticised by people working within the NHS on the grounds that it will deter people suffering from illness or injury from seeking medical advice in the belief that they will have to pay large bills for consultations. Though the numbers of people who received NHS health care in the ‘visitor’ category – against whom the rule is directed – is thought to be small there is a wider concern that rules of this nature will have a chilling effect on larger groups of migrants, including settled people, who are wrongly worried that these services are withheld from them due to the fact that they have no recourse to ‘public funds’.

These concerns were expressed at a conference on migrants and the NHS organised by City & East London Primary Care Trust and MRN in September last year.

Immediate concern
In the months since the new rule has come into force MRN has received reports of GP practices wrongly identifying people as being liable to a charge at private rates for consultation and treatment, due to the confusion around the implementation of the rules and the lack of guidance (read more about who is eligible for free NHS primary care).

This commonly happens at the point of registration with a practice. More worryingly we heard of instances in which UKBA officials have themselves identified individuals at the point of departure from the UK who have received services from GPs and who are regarded – as it has turned out, quite wrongly – to have incurred debts which they expected to be settled.

This mistaken presumption led to contact with GP practices with the request that they provide bills for services provided so that they could be served on the individuals leaving the country.

Supporting an initiative from the National Aids Trust aimed at lobbying the Department of Health to ensure that health services organisations would not be involved in open-ended information exchanges that would allow UKBA to pursue visitors and migrants who had come into contact with primary care services for payment , MRN wrote to the Under Secretary of State for Public Heath just before Christmas seeking assurances on these points.

In a reply dated 11 January the under secretary of state that that:

there are currently no powers to charge for NHS treatments in primary care. The process by which information will be shared by the NHS to enable the UKBA to apply these rules clearly only applies in respect of hospital treatment where charges have actually been levied and remain unpaid. It will not therefore be possible for these rules to be applied in respect of primary care treatment.

Welcoming this assurance we would like to see this message delivered loudly and clearly to GP practices and primary care trusts around the country. This would ensure that all staff know there are currently no powers to charge for NHS treatments in primary care. Migrant groups concerned about health services delivered to their communities should also be assured that information about the health services received by their members will not be routinely exchanged with UK Border officials.

This does not however address a wider issue of using immigration controls as a form of punishment for people with NHS debts and the fact that pursuit of this policy is likely to have a detrimental impact of public health in the UK. This is something MRN will continue to campaign on alongside other groups concerned about the effects of the policy on migrant communities.

Source Don Fynn (MRN)

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