The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 currently determine the rules over charging ‘overseas visitors’ for NHS care in England.
The BMA has been consistently critical of the regulations, which we believe have a negative impact on both patients and doctors. Following a DHSC (Department for Health and Social Care) review of the regulations, the findings of which have not been made public, the BMA conducted a survey of our membership to gain greater insight into how the regulations affect doctors daily work.
Our survey has provided clear evidence that the regulations are deterring vulnerable groups from accessing NHS treatment, threatening public health, and taking vital clinical time away from patient care.
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In 2015, the UK Government introduced new rules governing the charging of ‘overseas visitors’ accessing NHS services in England, with the stated intention of ensuring NHS bodies did not lose income by providing care to those not eligible for free treatment. The National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017 updated the rules on overseas charging, expanding charging to community services, introducing upfront charging for non-urgent care, and requiring NHS services to record patients’ eligibility for free treatment.
In early 2018, DHSC launched a review into the regulations. In December 2018, the Government announced that this review had been completed and had found no evidence of the regulations deterring patients from accessing care. The Government announcement and subsequent communications from DHSC have also made clear that the findings of the review will not be published. This is despite press reports that the review found evidence of patients being wrongly refused treatment due to misapplication of the regulations.
In 2018, we surveyed our members to better understand the experiences and views of the medical profession regarding the regulations, and to provide a clearer picture of the impact they have had in practice.
Our survey found that:
- many doctors have faced pressure from OVMs (Overseas Visitors Managers) when making clinical judgements regarding a patient’s need for care
- the regulations, and particularly upfront charging, are deterring patients from seeking care, including for treatments that are not chargeable
- based on their experiences thus far, our members have reported that the regulations are negatively impacting public health
- vulnerable groups are being, and will continue to be, negatively affected by the regulations
- the regulations have increased workload for doctors and wider teams, taking time away from patient care
The BMA recognises that in certain cases it may be appropriate to charge overseas visitors for the use of certain NHS services. However, it is vital that this system is cost-effective, practicable and does not unduly burden NHS workers. Access to urgent treatment must also always be prioritised over administrative concerns and safeguards must be in place to protect vulnerable populations, mitigate any public health risks and ensure that patients are not deterred from seeking care.
It is our strong and longstanding view that existing overseas charging regulations fail to meet these criteria and, moreover, have had a negative impact on both NHS staff and patients, including the most vulnerable.
The findings of our survey strongly reinforce these concerns and show that urgent action is needed to address them. We strongly believe that this action should include:
- a full and independent review into the impact of the regulations on individual and public health
- the full publication of the findings of the DHSC review of the regulations
- simplification of charging criteria and exemptions to improve clarity for patients and providers and reduce instances of their misapplication
- the introduction of safeguards to ensure that vulnerable populations are not deterred from seeking care, are able to access the care they are entitled to and that necessary treatment is not denied due to difficulty or delay in proving eligibility
- an investigation into OVM performance and action in cases of interference with clinical decision making
- rigorous testing of the cost-effectiveness of the regulations.
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