Migrants to face charges for A&E
Overseas visitors and migrants who require accident and emergency treatment from the NHS in England are to be charged, the Government has announced.
The move forms part of an extension of the NHS charging regime in England intended to deter so-called "health tourism" while recouping up to £500 million-a-year for the taxpayer.
Under the proposed changes, migrants and overseas visitors will have to pay for primary care services such as minor surgery carried out by GPs, while prescription charges will be extended.
There will also be higher charges for services which are subsidised for patients entitled to free NHS treatment - such as optical and dental care.
Ministers say that no one will be turned away from an A&E department in an emergency, but there will be a bill to pay afterwards for those from overseas.
Consultations with GPs and nurses will remain free of charge, to ensure initial access remains to prevent public health risks such as TB, HIV and sexually transmitted infections.
Details of the scheme are still being worked out, and ministers have said they will publish a full implementation plan in March.
Health Minister Lord Howe said: "Having a universal health service free at the point of use rightly makes us the envy of the world, but we must make sure the system is fair to the hard-working British taxpayers who fund it.
"We know that we need to make changes across the NHS to better identify and charge visitors and migrants. Introducing charging at primary care is the first step to achieving this.
"We are already looking at taking action and next year we will set out our detailed plans to clamp down on the abuse of our NHS."
The announcement comes amid fears among many Tory MPs that the ending of restrictions on migrants from Bulgaria and Romania on January 1 will see a major influx of immigrants, putting additional strain on the NHS and other public services.
Doctors' leaders warned the proposed changes could cost more to administer than they would actually raise for the NHS while deterring some people desperately in need of treatment from seeking care.
Dr Mark Porter, the chair of British Medical Association council, said it would cause confusion among patients while requiring GPs and hospital doctors to spend more time on paperwork and bureaucracy.
"This could mean the system of administering the new charging system will end up actually costing more to run than it collects in revenue," he said.
"There remains a real risk that some migrants and short term visitors who desperately need care could be discouraged from approaching the NHS if they cannot pay the proposed charges.
"There is particular confusion over access entitlements to emergency care services, given the proposals introduce charging for A&E visits yet say no patient will be turned away if they need care."
Dr Helen Stokes-Lampard, spokeswoman for the Royal College of General Practitioners, welcomed the decision not to extend charging to GP appointments, but said that they still had concerns.
"We still need reassurances that GPs are not going to be pressed into acting as an arm of the Border Agency and we remain unconvinced that the proposals will work across the NHS," she said.
"GPs have a duty of care to all people seeking healthcare and cannot be expected to police the system or prevent people from getting medical help when they are at their most vulnerable.
"We must be allowed to get on with our proper job of caring for patients, not form-filling and acting as a quasi form of immigration control."
For Labour, shadow health minister Lord Hunt of Kings Heath accused ministers of putting " spin before substance" in an attempt to grab the headlines.
"Labour is in favour of improving the recovery of costs from people with no entitlement to NHS treatment," he said.
"Rather than more grandstanding, the Government needs to deliver practical, thought-through changes to make that happen. Instead this out-of- touch Government is left asking doctors and nurses to act as surrogate immigration officials."
Lucy Jones, manager of Doctors Of The World's clinic in east London, warned that the plans could leave the most vulnerable without vital care.
She said: " Two-thirds of our patients reported difficulty accessing healthcare in the past year and one in five feared arrest if they sought medical help. More barriers will only make it harder for the most vulnerable to access vital healthcare, including pregnant women who could be too frightened to go to A&E.
"We are particularly concerned about the impact on children. Parents may feel unable to take their sick child to A&E because of fears they won't be able to pay.
"The proposed system will put further pressure on staff time and resources. Doctors and nurses should be focusing on treating the sick, not checking everyone's status to see whether they should be charged.
"The NHS is not designed to identify and charge a small group of patients; any system will have to be applied to the entire population. The staff time and resources needed to implement this are likely to outweigh any benefits.
"It will require frontline clinicians to make decisions about people's eligibility for care when they should be focusing on treating the patient. GP's must not become border guards."