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Overseas visitors; entitlement to primary care services
Overseas visitors entitlement to NHS treatment
(This Powerpoint Presentation may be used as a training aid. The first slide may then be
printed off to act as a Brief Guide to NHS Entitlement for quick reference, with the remaining slides providing additional detail.)
Index links:
Introduction
NHS Entitlement
Immediately necessary or emergency treatment
Registration on a GP List
Temporary residents
Private patients
Asylum seekers and refugees
EEA visitors
Non-EEA visitors
Walk-in Centres
Persons leaving the UK for more than 3 months
Secondary care
Specific advice
Further Information
Introduction
5 million people registered with a GP in 2002/03, including temporary residents and those seeking immediately necessary treatment. The Department of
Health does not know how many of these people were from overseas and how many were entitled to free NHS primary medical services.
In December 2003 the government initiated a consultation process with a view to changing and clarifying the rules on eligibility to free primary care and charging
those who would not be eligible under the new rules. This consultation ends on August 13th 2004.
Proposals to Exclude Overseas Visitors from Eligibility to Free NHS Primary Medical Services
Considerable confusion currently exists on the eligibility of overseas visitors to general practice. The following guidance may be helpful;
NHS entitlement
Entitlement to full NHS treatment does not depend upon past or present payments of UK taxes or National Insurance contributions. It hinges on the concept of
'ordinary residence.' A person may be regarded as ordinarily resident if they are;
"living lawfully in the United Kingdom voluntarily and for settled purposes as part of the regular order of their life for the time being.
Whether they have an identifiable purpose for their residence here and whether that purpose has a sufficient degree of continuity to be properly described as 'settled'."
The Department of Health has confirmed that this definition does not depend upon employment status, so a pensioner from abroad who is
living legally in the UK on a settled basis would be regarded as ordinarily resident.
Immediately necessary or emergency treatment
Every practice or walk-in centre has an obligation to provide any immediately necessary or emergency treatment to any patient that
presents, regardless of all other considerations.
This is defined as any essential treatment that in the clinical judgement of a health care professional cannot be delayed or avoided. This may
include immediately necessary treatment for a pre-existing condition that has become exacerbated while visiting the UK.
This is a longstanding professional obligation for all doctors and is also a legal requirement under all GMS and PMS contracts.
Practices are required to offer free emergency or immediately necessary treatment to anyone who:
- has been refused inclusion on the practice’s list of patients for up to 14 days from the date of refusal or until registered elsewhere - whichever is sooner
- the practice has refused to accept as a temporary resident for up to 14 days from the date of refusal or until accepted elsewhere - whichever is sooner
- is staying in an area for less than 24 hours, and in this case care should be given for a period of up to 24 hours.
Necessary drugs and dressings following this treatment are prescribed on an NHS prescription and supplied in the usual way. NHS prescription
charges may be applicable in the usual way.
Registration on a GP List
A GP practice may, however, accept any patient, including overseas visitors from any country, on to its list.
It has discretion to accept anyone who applies or to refuse to accept anyone, provided there are reasonable grounds for doing so which do
not relate to the applicant’s race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.
Under GMS 2 you must provide any patient with a written reason for your refusal to register him or her and you must keep a record of this for the PCT.
You must make it absolutely clear that you have refused acceptance on a non-discriminatory basis, perhaps because you only register patients that
you regard as 'ordinarily resident'.
In terms of ordinary residence entitlement, many people would consider a six month period of work in this country as indicating a settled
purpose, but this is not a fixed concept.
Practices may routinely ask prospective patients for proof of address to confirm their residence in the practice area.
Registration on a GP list entitles a person to free NHS primary medical services, but it does not automatically entitle an individual
to other NHS services, such as secondary care, dental care or prescriptions free of charge.
If you refuse to register a patient, the PCT may allocate him or her to your list if they regard that person as ordinarily resident, unless your list
has been formally closed.
Temporary residents
A practice may accept anyone that lives in an area for more than 24 hours, but not more than 3 months as a temporary resident.
Private patients
If a person has not been accepted onto a GP’s permanent list or accepted as a temporary resident the GP may provide treatment on a private basis.
In the past the Department of Health has positively encouraged GPs to offer private treatment, rather than NHS care for 'NHS Tourists'.
Asylum seekers and refugees
Asylum seekers and refugees who have been given leave to remain in the UK, or who are awaiting the results of an application to remain or an
appeal, are entitled to register and receive free NHS primary medical services.
There is no obligation to produce documentary evidence of identity, or for practices to ask for it, but the Department of Health and the Refugee
Council recognise that relevant documentation may assist the process of registration. Many asylum seekers offer to show their Application Registration Card (ARC) issued by the Immigration Service as proof of
their status.
If an asylum seeker loses their claim to asylum and all appeal processes have been exhausted, they become ineligible for routine NHS primary
care treatment from the date their asylum claim failed. These patients may then be treated as private patients.
The fact that a foreign visitor’s papers have been marked with ‘no recourse to public funds’ does not relate to NHS entitlement, but only to
social security benefits.
EEA visitors
Visitors from EEA member states or Switzerland are entitled to ‘all necessary’ care, including for pre-existing chronic conditions.
A passport or national ID card is acceptable as proof of entitlement, and no other EU documentation is required.
EEA or Swiss visitors may, however, choose to provide forms;
- E111** - proof of entitlement to all necessary care. The exception
is treatment if the patient has travelled to the UK specifically to receive that treatment. Some international transport workers such as truck drivers may also have the similar E110
- E112 - entitlement to treatment which the patient has come to the UK specifically to receive e.g. an organ transplant
- E119 - similar to E111** but held by jobseekers
- E128 - issued to posted workers and some students who are entitled to all necessary treatment.
The Department of Health has confirmed that, if an EU citizen is in receipt of incapacity benefit or a retirement pension, then his health
expenses could be covered by his home state under the E106 or E121 arrangements if he or she takes up residence here.
Footnote (28/04/05):
The Department of Health has recently confirmed that ‘all practice
surgeries in the UK are obliged to abide by any EU law in place with regard to receiving medical treatment.
EU law supersedes national law and no surgery is exempt from this. Any surgery which does not abide by EU law could be taken to the European
Court of Justice for infraction.
The EU law, as it stands at the moment, states that:
“From 1st June 2004 EU residents who are temporarily visiting another
Member State are entitled to receive any necessary treatment which their state of health requires during their stay, on the same terms as an insured resident of the country being visited. This includes on-going
medical care for pre-existing conditions i.e. medication, blood tests and injections.”
The Department of Health is currently in the process of preparing guidance specifically for GPs on this and other issues and will be
distributing this to all NHS stakeholders later this year.
** Footnote (16/05/06);
The E111 is no longer valid since January 2006 and has been replaced by the EHIC.
Non-EEA visitors
The UK has a bilateral health agreement with a number of non-EEA states. (Bilateral healthcare agreement countries).
These entitle their nationals or residents to immediately necessary treatment. A passport or residence document demonstrates entitlement.
However, it is our understanding that this is a normal primary care entitlement for anyone who requires such treatment and thus these reciprocal arrangements relate predominantly to secondary care entitlement.
Further information is available on the Department of Health's Overseas Visitors Home page
Rules on eligibility to access free NHS hospital treatment
Are you visiting the United Kingdom from a country with a bilateral healthcare agreement?
Walk-in Centres
All treatment provided by NHS Walk-in-Centres that are associated with A&E departments is now provided free to all who seek treatment.
Other NHS Walk-in-Centres apply NHS charges to overseas visitors who are not eligible for free NHS hospital treatment.
Emergency or immediately necessary treatment is provided free of charge.
Persons leaving the UK for more than 3 months
Persons who have left the UK, or who are intending to leave the UK for more than 3 months, are not normally allowed to continue to be
registered with a practice.
Secondary care
GPs may refer an overseas visitor to hospital for further investigation or treatment. However, being registered with a practice does not give a
person automatic entitlement to free secondary care. This may make provision of primary care particularly difficult for a GP if the
patient is not entitled to free secondary care or investigations and cannot afford to pay privately.
The Department of Health has suggested that GPs identify any patient that they refer to hospital who is known to be an overseas vistor and
may therefore be liable to hospital charges.
Hospitals must establish whether a patient is ordinarily resident in the UK. If a person is not ordinarily resident and is not covered by one of the
statutory exemptions listed in the National Health Service (Charges to Overseas Visitors) Regulations 1989 (as amended), they are liable to be charged for that treatment. These regulations are listed in Annex B of
the consultation document.
The National Health Service (Charges to Overseas Visitors)
(Amendment) Regulations 2004 - SI 2004 614
Specific advice is available from the various government departments
dealing with these issues on an everyday basis. The direct telephone numbers are;
Asylum seekers - 0113 2546605
Primary care - 0113 254 5256
Secondary care
- 0113 254 5819
Further Information:
Overseas visitors entitlement to NHS treatment
(This Powerpoint Presentation may be used as a training aid. The first slide may then be
printed off to act as a Brief Guide to NHS Entitlement for quick reference, with the remaining slides providing additional detail.)
DOH guidance on Oversea Visitors
Overseas Visitors - who do you treat?
CED 09/08/04 (updated 28/11/05)
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