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Cracking down on health tourism

Hard-wired GP

Luke Koupparis

Thursday, 02 February 2017

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Medical tourism_shutterstock_567679804.jpgSo, the Public Accounts Committee has suggested that the whole system of getting money back for overseas patients accessing NHS services is in a right mess and needs sorting out. They state that the failure to get a grip on recovering the costs of treating overseas visitors is depriving the NHS of vital funds and it is simply unacceptable that so much money owed should continue to go uncollected. In the year 2015-16, £289 million was collected up from £97 million in 2013-14, but this was due to a change in the charging rules rather than the trusts collecting more efficiently.

Now, who do you think they plan to rope in to take on this role? Yes, you have guessed it - primary care. The committee recommends that the Department of Health should issue guidance by the summer of 2017 on how GPs can help with this role. GPs! Really? With this new role they feel that they will achieve their projections of recovering £500 million a year by 2017-18.

Despite having no mechanism for us to police who is and who isn’t eligible for NHS care and no training on the complex rules of who and who isn’t eligible, we are faced with having to be the border control police when a patient present to see us. Currently, the rules are difficult to understand let alone implement on a daily basis.

I completely appreciate that the NHS has limited resources, but surely there should be a system that determines whether a patient is eligible or whether an invoice is required for any treatment BEFORE they hit the poor receptionist on a Monday morning? It is not difficult to imagine the scenario where an admin member of staff is tied up with dealing with overseas eligibility causing an ever-increasing queue of disgruntled patients desperate to get the last book-on-the-day appointment. We also cannot be expected to somehow monitor failing trusts who are clearly falling short of charging eligible overseas patients. It just isn’t our job to police secondary care.

I do wonder whether this is yet another diversionary tactic, aimed at avoiding the key issue that there is just not enough funding coming into the NHS for it to survive in its current form.

However, one large-scale solution to this issue would be for primary care to start charging all patients, who then claim back the cost from a national body, that regulates who should pay what. It would take some planning and managing, but other countries run a system like this and it seems to work well. At least by this mechanism, any overseas patients would be flagged and would either need to pay-up or would need an invoice sending back to their home country for payment. If this change was made, maybe we could also remove the slightly archaic rules that prevent GPs from charging their own patients. This may help to fund the increasing number of services that are no longer provided under the NHS umbrella of free for all. Having a mechanism of payment, albeit with reimbursement, may allow the general public to put a monetary value on their use of the healthcare system.

Or perhaps another way to make this work would be to allow primary care to keep a proportion of all income gained by charging overseas patients. Those practices who had high numbers of overseas patients would then have a much-needed cash injection that may allow them to invest in greater numbers of clinical staff to address this demand.

I do agree that we need to have a clear system that identifies those who are not eligible for free care or where we have a reciprocal arrangement on funding. However, I am not sure it is up to GPs to become the gatekeeper border force, potentially being blamed when it doesn’t add up to quite enough money required to hit arbitrary targets and thereby saving the NHS from financial meltdown.

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Luke Koupparis

Luke is a general practitioner in the Bristol area with interests in men's health, child health, minor surgery, online education and medical information technology. He is the IT lead for Bristol clinical commissioning group. He also works as the medical editor to OnMedica helping to deliver high quality, peer reviewed information to the wider medical community. In his spare time he is a keen road cyclist.
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