Eligibility for NHS primary care
Of course, there is constant tension between on the one hand pressure to cut costs, and antagonism towards the idea that money contributed by UK citizens is being spent on "immigrants" and "health tourists" mean that cutting support for people who can be portrayed as not deserving it is very attractive to politicians; while on the other hand evidence as to why it might be a good thing to e.g. treat visitors with infectious diseases rather than allowing these diseases to spread to UK citizens. Entitlements are likely to be discussed, and may well change.
See Eligibility for NHS secondary care for information on eligibility for e.g. hospital treatment.
Since this document was first drafted the new GP contract has been introduced, the original key reference (HSC 1999/018) has gone "out of time", and the systems by which GPs are paid for providing "immediately necessary" and "emergency" treatment have been changed. Revised guidance has been published, and the basic facts about eligibility for NHS treatment have not changed (as the underlying legislation has not been amended). Links to current guidance are included below. Devolution is likely to have made some of the detail below inaccurate, as has the introduction of an health insurance component to some types of visas._
How to decide if somebody is eligible for NHS treatmentPeople are eligible for NHS treatment, like any UK citizen, if they are "ordinarily resident" in the UK (see Residence in the UK below).
European economic area (EEA) nationals carrying Form E128 are also fully eligible for NHS treatment. (see Visitors from EEA members... below).
People who are visiting the UK, but who are not "ordinarily resident" in the UK are entitled to "immediately necessary treatment" from a GP.
Visitors to the UK may carry a Form E112, which entitles them to seek treatment for a specific condition – see DH guidance (in References and external links, below) for details.
People entering the UK from certain countries, who expect to stay here for at least 6 months, may be referred to the PCO or HPU where they expect to reside for new entrant screening. If a patient presents to a GP practice carrying a letter asking them to register for a GP, and/or a chest x-ray report or request form from the PCO or HPU, it is almost certain that this is because the immigration officials at the port of entry have confirmed that they are eligible for NHS primary care.
Residence in the UK
Health services circular HSC 1999/018 refers mainly to people who are not classified as resident. It states (in paragraphs 2 and 3):
The National Health Service is primarily for the benefit of people who live in this country. It is therefore considered that eligibility to receive free medical treatment should relate to whether a person is ordinarily resident in the United Kingdom (UK) and not to nationality, the payment of National Insurance contributions or taxes.
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 as part of the regular order of his or her life for the time being. A person must have an identifiable purpose for his or her residence here and that purpose must have a sufficient degree of continuity to be properly described as settled. It is unlikely that anyone coming to live in the UK, intending to stay for less than 6 months, will fulfil these criteria.
Advice received on calling the Department of Health’s advice line (020 7210 4850). is consistent with HSC 1999/018 (and confirmed in more recent publications). The rule of thumb they gave was that somebody is ‘ordinarily resident’ if both of the following apply:
- They will be in the UK for at least 6 months.
- Their passport is open-ended – allowing them to stay for at least 1 year, without any restrictions.
Please note that some people – including, for example, some au pairs from non EU countries – might have passports or visas stamped with a statement that they are not entitled to state benefits. This does NOT apply to NHS treatment if they meet the eligibility criteria above.
Asylum seekers and refugees (including asylum-seekers – see Refugees below) are regarded as “ordinarily resident”. (Recent guidance from DH that asylum seekers should no longer be considered "ordinarily resident" and entitled to free primary care has been rescinded following a recent judgement - there is a letter from DH detailing the current position.)
Immigration officials report some new entrants to the local PCT or Health Protection Unit (HPU), so that they can be offered screening for e.g. tuberculosis. Only people who will be staying in the UK for over six months are so notified, so if a patient attends a practice with a letter from the PCT or HPU asking them to register with the practice, it can be assumed that they are bona fide examples of people who are eligible for NHS treatment.
Visitors from EEA members states carrying Form E128
In paragraphs 18 & 19, regarding visitors from EEA member states carrying Form E128, HSC 1999/018 states (and confirmed in more recent publications) states:
This form … applies to two groups of EEA nationals only: *workers posted temporarily to another member state and any members of their family who accompany them; and *students temporarily in another member state to study and any accompanying members of their family.
For people in these two groups who come to the UK, form E128 will give entitlement under the NHS to necessary treatment for any condition, that is their entitlement is not restricted to treatment that is immediately required. Routine treatment for on-going conditions existing before arrival in the UK cannot be excluded, and such patients should, in effect, receive full health care under the NHS on the same terms as UK residents. They may either be accepted by the GP of their choice, or be assigned to a GP by the Health Authority. As an NHS patient, the overseas visitor carrying form E128 should not be treated on a private, paying basis.
(See also Asylum seekers and refugees.)
In paragraph 27, HSC 1999/018 (and confirmed in more recent publications) states:
A refugee given leave to remain in the UK should be regarded as ordinarily resident. A refugee who is in the UK awaiting the result of his application to remain in this country should also be regarded as ordinarily resident because he or she is residing lawfully for a settled purpose.
The HSC includes detailed information on the entitlements of overseas visitors who are not technically “resident” in the UK (not repeated here).
Emergency or immediately necessary treatment
Treatment within an accident and emergency department, or emergency/immediately necessary treatment from a GP is free to overseas visitors.
"Under the new GMS contract or PMS agreement, a practice is required to offer free NHS treatment to anyone who requests it, if, in the opinion of a clinician, it is immediately necessary. This is essential treatment, which in the clinical judgement of a health care professional cannot be delayed or avoided." (DH/HSCD-ACCESS-PC. Annex A, para 16, p16)
Sexually transmitted diseases
No charge is made for the treatment of sexually transmitted diseases, except for HIV. Diagnosis and counselling are provided free for HIV, but not treatment. (DH/HSCD-ACCESS-PC. Annex B. Full list of exemptions from charges for hospital treatment.)
Public health Schedule I diseases
No charge is made for the treatment of notifiable diseases public health (control of disease) act 1984, section 10 (1984 c. 22) and Public health (infectious diseases) regulations 1985 (S.I. 1985/434): Cholera, Food poisoning, Plague, Relapsing fever, Smallpox, and Typhus. (DH/HSCD-ACCESS-PC. Annex D. Exempt diseases for which no charges can be made.)
Anybody detained by the criminal courts (including on probation), or under the mental health act, is eligible for free NHS treatment.
The "rules" are not entirely clear for interventions such as immunisation against infectious diseases, and screening for tuberculosis, where the purpose is at least partly to protect the health of the population.
If people have problems registering with a GPAnybody who is entitled to free NHS treatment is entitled to register with a GP. If they expect to move out of the practice area within three months they should be registered as a temporary resident.
GPs do not have to accept anybody onto their list, or to give any reason for refusing to admit anybody to their list. That said, if they are refusing to accept anybody onto their list because they have misunderstood the eligibility criteria, then they may be happy to change their minds once they have been reassured that they may provide NHS treatment.
- It’s Your Practice A patient guide to GP services RCGP 2011
- "England Migrant health guide"
- "Overseas Visitors to Scotland"
- "Overseas Visitors to Wales"
- Good "reading list" of resources (mostly with web links) relating to refugee health care, from The Kings Fund.
- BMJ article "Restricting access to the NHS for undocumented migrants is bad policy at high cost"
- Are you taking up or resuming permanent residence in the UK? Rules, procedures and documentation on access to hospital and primary health care, NHS charges and exemptions. Not dated. Last viewed 2010 (31 July).
- Department of Health. HSC1999/018. Overseas visitors' eligibility to receive free primary care: a clarification of existing policy together with a description of the changes brought in by the new EC health care form E128. London, 1999.
- Entitlements to NHS care page in the Migrants and the NHS area of the HPA web site. (Undated and possibly out of date, but otherwise very useful.)
- DH/HSCD-ACCESS-PC. Proposals to exclude overseas visitors from eligibility to free NHS primary medical services: a consultation. London: Department of Health, 2004. Within this document there are various particularly relevant annexes, including:
- Annex A. NHS primary medical services - an explanation of the current rules.
- Annex B. Full list of exemptions from charges for hospital treatment.
- Annex D. Exempt diseases for which no charges can be made.
- DH page with resources for asylum seekers and refugees (some of the ASCT newsletters you can download from that page contain some very useful links).
- DH leaflet for refugees and others ("This fact sheet has been written to explain the role of UK health services, the National Health Service (NHS), to newly-arrived individuals seeking asylum. It covers issues such as the role of GPs, their function as gatekeepers to the health services, how to register and how to access emergency services.")
- NHS charges for people from abroad - guidance from the Citizens Advice Bureau.
- Asylum Support
- Refugee Council
- "Overseas visitors accessing NHS primary medical services." From the General Practitioners' Committee of BMA (GPC).
- Lords Hansard, 14 Jan 2002 : Column WA141. GP Registration: Non-British Subjects (states: "If a non-British subject presents for registration at a general practitioner the following occurs. If they state they are to be in the country for less than three months, the GP completes a temporary services (GMS3) form. If they state they are to be resident in the country for over three months, the patient is registered with the GP using the GMS1 form. These forms are submitted by the GP to the local health authority.")
- International Organization for Migration (and a document from them about pre-entry TB screening.
- NHS Counter Fraud Service. Guidance to GP practices on GP patient registration fraud: NHS, Undated (Status uncertain; document on Pulse web site.)
- ↑ Failed asylum seekers and ordinary residence. Department of Health Dear colleague letter to Chief Executives. 1 May 2008. Gateway Reference 9854.
- ↑ British Medical Association. Access to health care for asylum seekers and refused asylum seekers – guidance for doctors. London: BMA, 2012.
- ↑ Department of Health. Overseas visitors: pandemic flu. Last modified 17 June 2009. Last viewed 23 June 2009.
- ↑ Statutory Instrument 1166. National Health Service (Charges) (Amendments Relating to Pandemic Influenza) Regulations 2009
- ↑ Department of Health International Health and Public Health Policy Division. Guidance on implementing the overseas visitors hospital charging regulations: Department of Health, International Health and Public Health Policy Division, 2013 (31 October).
- ↑ The National Health Service (Charges to Overseas Visitors) Regulations 2015 (Statutory Instrument). 2015 No. 238. London: The National Archives, 2015
- ↑ [Kings Fund. Reading list: Refugee health care. London: The Kings Fund, 2012 (April); 1-22
- ↑ Keith L, van Ginneken E. Restricting access to the NHS for undocumented migrants is bad policy at high cost. BMJ 2015;350:h3056.
- ↑ General Practitioners Committee. Overseas visitors accessing NHS primary medical services. London: British Medical Association, 2011 (February)