Overseas visitor charge for using A&E

Okell

powerful_Rogue said:

OP might find this useful.

https://www.gov.uk/government/publications/debt-to-the-nhs-border-force-officer-guidance/nhs-debtors-accessible

That is interesting for three reasons.

First, A&E is free for everyone, including non-uk residents

Second, NHS trusts are obliged by legislation to charge non-uk residents for the provision of secondary* healthcare - there is no requirement for any kind of agreement or contract or understanding on the part of the patient.

Third, "Individual NHS bodies decide who is eligible for NHS treatment and who is charged..."


*Apparently A&E counts as primary healthcare even though delivered in a secondary healthcare setting.

Flugelhorn

Okell said:

*Apparently A&E counts as primary healthcare even though delivered in a secondary healthcare setting.

that is really interesting - having worked in "Primary Care" ie GP land, I get the feeling that A&E would hate to be lumped in with us

I presume they are considering that secondary is treatment and assessment following the initial referral 

GrubbyGirl_2

Okell said:

powerful_Rogue said:

OP might find this useful.

https://www.gov.uk/government/publications/debt-to-the-nhs-border-force-officer-guidance/nhs-debtors-accessible

That is interesting for three reasons.

First, A&E is free for everyone, including non-uk residents

Accident and Emergency services are absolutely free for everyone and should continue to be so.  However A&E services are consistently abused by many many people.  It is clear in this case that the attendance at the A&E department was neither an accident or emergency and she was therefore was rightly charged for the service.  Maybe if UK residents were also charged, even a nominal amount, it might reduce the abuse of A&E services and allow them to focus on the job they are there to do.

Andy_L

cmthephoenix said:

My wife used to work in A&E Reception. I kid you not that people would wait 4+ hours so they could get paracetamol for free rather than pay Lidl 29p for them.

Anyway as has been pointed out NHS is now really hotting up on charging overseas visitors even for A&E visits. It's been made a lot simpler as border control has become more and more computerised.
It's only going to go in one direction with the ever balooning NHS budget force feeding the introduction of AI in more areas. 

Seems unlike since. as pointed out up-thread, A&E is free regardless of residency status

Andy_L

EnPointe said:

Brie said:

I'm a bit foggy about my last visit to A&E or any previous ones but despite having an obvious non British accent I was never asked about my residency status or saw anything to indicate that non UK residents would be charged for any treatment.  

I'm not saying that non UK residents shouldn't be charged but just that someone should have stated it outright that there would/might be a charge.  

As for the OP I might suggest that you discuss this further with the department that sent you a letter and perhaps agree that SiL would pay a small amount monthly.  This might come from your bank account but it would remain her debt - that may be sufficient to satisfy Border Control.   ( @Exodi -  your thoughts?  or your wife's??)

you have have an NHS number and  are you  registered with a GP ?    those  would  suggest you meet the habitual residence test  if the address you  gave when registering matches up with the Spine 

You can register with a GP without being resident( (like A&E eligibility to NHS GP services are not based on residency). You get an NHS number the 1st time you are treated by the NHS, so the OP's sister now has an NHS number.

Okell

Flugelhorn said:

Okell said:

*Apparently A&E counts as primary healthcare even though delivered in a secondary healthcare setting.

that is really interesting - having worked in "Primary Care" ie GP land, I get the feeling that A&E would hate to be lumped in with us

I presume they are considering that secondary is treatment and assessment following the initial referral 

Well that's my interpretation of this section:


"Primary Health Care, General Practice (GPs) and Secondary Health Care

Primary Health Care provides the first point of contact into the Health Care system. Within the NHS, the main source of Primary Care is General Practitioners (GPs).

Secondary Health Care is provided within a hospital, following a referral from a GP or as a result of the requirement for further treatment following an admission to Accident and Emergency (A&E) which is deemed as primary care.  [my bold for emphasis]

Treatment within an A&E department and at a GP surgery is free to all, regardless of immigration status."

So I read it as primary care free to all irrespective of resident status, secondary care chargeable to non-residents.

(In my experience A&E would benefit from being lumped in with GPs.       But I've got a really good GP practice)

Okell

GrubbyGirl_2 said:

Okell said:

powerful_Rogue said:

OP might find this useful.

https://www.gov.uk/government/publications/debt-to-the-nhs-border-force-officer-guidance/nhs-debtors-accessible

That is interesting for three reasons.

First, A&E is free for everyone, including non-uk residents

Accident and Emergency services are absolutely free for everyone and should continue to be so...

I'm not sure about that.  I think there's an argument to be had over non-UK residents in the absence of a reciprocal agreement and where they either have travel insurance or can afford to pay.

Grumpy_chap

Okell said:

(In my experience A&E would benefit from being lumped in with GPs.       But I've got a really good GP practice)

I really don't know how that would work.
With my GP, the only way to see them is to call at 08:00 on the dot and be amongst the first in the queue and then, if you are lucky, they will offer an appointment some time three weeks later.  If you miss all the slots released that day, you get told to call back the next day at 08:00 or to go to A&E if the matter is urgent.

Also, I do not believe that GPs have all the facilities required to adequately respond to all the wide variety of conditions that present to A&E.  Our GP can take blood tests (with an advance appointment) but then sends the sample away for analysis and gets the results after a few days.

In my experience, you could only make A&E part of the GP practice if you restrict it to people who have an accident or emergency requiring a minor level of intervention at 07:59 in the morning Monday- Friday and can wait three weeks or so

Okell

@Grumpy_chap  -  I think I wasn't clear and you've misunderstood.

I may be wrong but I believe that what @Flugelhorn was getting at was that A&E would not want to be metaphorically lumped together with GPs in the provision of primary care because A&E staff consider themselves to be "higher" than GPs in the NHS hierarchy because they work in a secondary care setting - although the NHS apparently does not consider A&E to be a secondary care service.

Now I'm not suggesting that A&E services should be physically amalgamated into GP surgeries, but my personal experience is that A&E has nothing to boast about in the provision of a service compared to GPs.

My experience may not be common, but as I said I'm fortunate to be registered at an excellent and well run GP practice.  If you want to make an appointment  there's none of this having to ring back tomorrow at 8am.  They simply book you an appointment with a doctor.  

To give a recent example I rang my surgery at about 4pm on Thursday 26 June and was given an appointment three working days later in the morning of Tuesday 1st July.  On that Tuesday I booked a hypertension review which I had two days later.  Following the 1st July GP consultation I had a hospital x-ray yesterday, just 9 days after it was requested by my GP.  And the day after my hypertension review the practice contacted me to tell me that they had arranged a telephone consultation for me on Saturday 19 July to discuss the results.  Excellent service overall.

Moreover, a few years ago, the day after a fruitless visit to A&E my wife got me a same day GP appointment and as a result of that appointment I had an immediate emergency admission to hospital.  My wife still believes that prompt action by my GP on that day probably saved my life.

As a former NHS manager I don't like knocking the NHS but my personal experience is that my GP practice provides a service that would be extremely difficult to better, and that my local A&E service doesn't compare.


[Edit:  Just to be clear, apart from A&E - which I accept has its own problems - I've had lots of experience of hospital outpatient care over the last ten years or so and I generally can't fault it.  Provision has been faultless]

Flugelhorn

Okell said:

@Grumpy_chap  -  I think I wasn't clear and you've misunderstood.

I may be wrong but I believe that what @Flugelhorn was getting at was that A&E would not want to be metaphorically lumped together with GPs in the provision of primary care because A&E staff consider themselves to be "higher" than GPs in the NHS hierarchy because they work in a secondary care setting - although the NHS apparently does not consider A&E to be a secondary care service.

I was indeed being slightly tongue in cheek. As a GP we ran an excellent service in a shoestring budget compared with the hospital budgets. We had many decades more experience than the young doctors in A&E and didn't rely on instant access to blood tests / fancy x-ray machines etc. 

many a time we would offer someone an appointment in a couple of hours, they would decline and head off for what they thought was a better service in A&E where they would wait for 4 hours .... and referred back the GP ... hey ho. glad I am retired