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Overseas visitors and NHS treatment

BMA Guidance Overseas visitors accessing NHS primary medical services Feb 2011Download

Hospital Charging Regulations Aug 2011 Download

NHS eligibility
Patients stating they are temporary visitors to the UK
Residents of EEA countries and their entitlement to treatment
Bilateral healthcare agreements
Visits specifically for medical treatment
Patients stating they plan to reside in the UK / Registering overseas visitors

NHS eligibility
Past or present payment of UK taxes or National Insurance contributions are not taken into account when establishing eligibility to receive free NHS treatment. NHS eligibility relates to being ‘ordinarily resident’ in the United Kingdom. Overseas visitors are defined as persons of any nationality, including British nationals, not ordinarily resident in the UK.

The courts have decided that a person is regarded as ‘ordinarily resident’ in the UK if he or she is lawfully living in the UK voluntarily and for a settled purpose. Ordinarily resident is a common law concept considered by the House of Lords in 1982 (the case being considered was in the context of the Education Acts, although the Lords’ interpretation is generally accepted as having a wider application).

Anybody who is in the UK for ‘a settled purpose’ will normally be considered to be ‘ordinarily resident?; in practice, following court cases, this means anyone who is in the UK for a period of six months or more. Special regulations apply to European Economic Area (EEA) residents and visitors from bilateral healthcare agreement countries.

Patients stating they are temporary visitors to the UK
As NHS contractors, GPs have a duty to provide immediately necessary treatment to any patient within their practice area regardless of whether or not that patient is otherwise entitled to NHS care. GPs are entitled to use their clinical judgement to determine what constitutes immediately necessary care. This is likely to include immediately necessary treatment that is required to treat not only new conditions but also pre-existing conditions that have become exacerbated during the period of a person’s stay in the UK, as well as prescriptions for medication without which the patient’s symptoms may become exacerbated.

At present, in theory, GPs can use their discretion regarding the treatment of overseas patients. They can register overseas visitors as temporary residents or, if they are in the UK for over three months, may accept them onto their lists. Once a person is accepted onto a practice’s list they are entitled to receive free NHS primary medical services (but not necessarily other NHS services (footnote 2) free of charge (like all NHS patients they may still be subject to prescription charges and may still be subject to hospital charges). In practice therefore the current regulations mean that practices have the discretion to offer NHS treatment to most people, whether or not they are overseas visitors. A person who is not automatically eligible for NHS care and who has not been accepted onto a GP practice list or accepted as a temporary resident can still be treated by a GP but on a private basis, for which they may be charged.

Residents of European Economic Area (EEA) countries and their entitlement to treatment
The regulations relating to the European Health Insurance card (footnote 3), which was introduced on 1 July 2004, state that ‘EU residents who are temporarily visiting another member state are entitled to receive anynecessary treatment which their state of health requires during their stay, on the same terms as a resident of the country being visited. This includes on-going medical care for pre-existing conditions i.e. medication, blood tests and injections.’ This is in line with HSC 1999/018 that states ‘when overseas visitors (i.e. those not ordinarily resident in the UK) require the provision of emergency or immediately necessary medical treatment, they should be offered this free of charge’. GPs remain entitled to charge for treatment that is not immediately necessary.

All people insured under, or covered by, a social security system of a member state and who are eligible for care in that member state are entitled to be issued with the European Health Insurance Card. It should be used by those staying temporarily, not permanently, in another member state. The card only relates to necessary care, such as breaking a leg, developing a chest infection or on-going care for a serious medical condition. It will not cover someone who decides to have treatment for a condition in another member state and does not confer any extra rights above and beyond the old E111.

EEA countries now include: Austria, Belgium, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Republic of Ireland, Slovakia, Slovenia, Spain, Sweden plus Iceland, Liechtenstein and Norway. Switzerland is also included by special arrangement.

Bilateral healthcare agreements
Bilateral healthcare agreements have more significance for hospital treatment than for primary medical care. However, in theory, as with all overseas patients, GPs currently have discretion to accept patients from a country with a bilateral healthcare agreement as a temporary resident or include them on their list should they choose to do so. Equally, other than for emergency or immediate necessary treatment, they can offer to treat a patient privately on a fee-paying basis. Countries which have some form of a bilateral healthcare agreement with the UK are: Armenia, Azerbaijan, Belarus, Bosnia, Bulgaria, Croatia, Georgia, Gibraltar, Yugoslavia i.e. Serbia & Montenegro, Kazakhstan, Kirgizstan, Macedonia, Moldova, New Zealand, Romania, Russia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan and residents of the following countries: Anguilla, Australia, Barbados, British Virgin Islands, Channel Islands, Falkland Islands, Iceland, Isle of Man, Montserrat, St. Helena, Turks and Caicos Islands.

Visits specifically for medical treatment
Any visitor who attends specifically for medical treatment is not normally entitled to NHS services, although, under certain circumstances, particularly relating to EEA countries, eligibility may exist.

The European Health Insurance Card does not cover someone who decides to have treatment for a condition in another member state. Planned treatment will only be provided with the agreement of the person’s insuring institution or national social security administration. A person who has emigrated from the UK would not normally be entitled to receive treatment that is neither an emergency nor immediately necessary, based on the fact that they are not ordinarily resident.

Patients stating they plan to reside in the UK /Registering overseas visitors
Practices should manage an application for registration from an overseas visitor who is in the area for a period of more than six months in the same way as any other applicant. The practice may accept the patient as an NHS patient but, if unwilling to do so, must give reasons that are not related to any form of discrimination. A practice may decline to accept the person as an NHS patient, inform them of their eligibility to NHS services and treat the patient privately. Dependents who accompany those who are working or are students in the UK for more than six months are entitled to NHS services based on the eligibility of the student/worker.

Practice staff can seek to determine a person’s eligibility to free NHS primary medical services. A practice may reasonably ask for evidence of duration of stay and students should normally be able to produce a document from their institution. Passports and visas may help with identification but any reference to ineligibility to public funds does not include the NHS.

 

European health insurance card

http://hacking-medschool.com/ehic

 

Age discrimination

Age Discrimination

 

Disability

http://hacking-medschool.com/learningdifficulties

Disability and Mobility Aids PUK