Can I treat a patient who lives overseas or is not a British citizen and is visiting our country?
Yes, anyone in England, regardless of nationality and residential status, is eligible to register and consult with a GP, this includes all overseas visitors, asylum seekers and refugees, students, and people on work visas, irrespective of immigration status. Practices can only refuse to register a patient if they have “reasonable grounds” to do so and any decision must not be discriminatory.
A patient does not need to be “ordinarily resident” in the country to be eligible for NHS primary medical care – this only applies to secondary (hospital) care. In effect, therefore, anybody in England may register and consult with a GP without charge.
Where a GP refers a patient for secondary services (hospital or other community services) they should do so on clinical grounds alone; eligibility for free care will be assessed by the receiving organisation.
It is important to note that there is no set length of time that a patient must reside in the country in order to become eligible to receive NHS primary medical care services.
Therefore all asylum seekers and refugees, students, people on work visas and those who are homeless, overseas visitors, whether lawfully in the UK or not, are eligible to register with a GP practice even if those visitors are not eligible for secondary care (hospital care) services. The length of time that a patient is intending to reside in an area dictates whether a patient is registered as a temporary or permanent patient. Patients should be offered the option of registering as a temporary resident if they are resident in the practice area for more than 24 hours but less than 3 months.
Can I charge?
Practices are not permitted to charge overseas patients – including tourists – for registering or consulting with a GP.
What is the indemnity situation with overseas patients? Is it different?
As they will be receiving NHS primary care services, this will be covered under the Clinical Negligence Scheme for General Practice (CNSGP)
How is the situation for GP practices different from the situation for hospital care?
Following the UK’s departure from the EU, The DHSC updated their ” Guidance on implementing the overseas visitor charging regulations“. This guidance provides information for NHS bodies who need to make and recover hospital charges from overseas visitors, however, it refers to and highlights that a patient does not need to be ordinarily resident in the UK to be eligible for NHS primary medical care. Therefore, anybody in England, including overseas visitors, may fully register as an NHS patient or as a temporary resident if they are to be in an area for between 24 hours and three months, and consult with a GP without charge. This applies even if they may be chargeable for non-exempt relevant services.
So whereas all overseas patients are entitled to receive NHS primary care at a GP practice only certain patients have a right to free secondary care. NHS England guidelines advise GPs to refer patients for secondary services on clinical grounds alone; it is the receiving organisation, not the GP, who is to assess a patient’s eligibility for free secondary care.
Should I register a patient as temporary or permanent?
A patient should be registered as temporary if they intend to be resident in the practice area for more than 24 hours but fewer than three months. If the patient intends to reside in the practice area for longer than three months, they should be registered as permanent.
Do I need to ask for proof of address?
Practices are not contractually obliged to ask for proof of address. While practices may ask for proof of address for practical reasons, a patient’s inability to provide this would not be a sufficient reason to refuse their registration.
So, if a patient claims to reside within the practice area but is unable to prove this, the practice must register the patient in the absence of evidence to the contrary.
 | The BMA are encouraging practices to use the Doctors of The World Safe Surgeries Toolkit |
What if they live outside my boundary?
If there is evidence that a patient lives outside of the practice boundary, GP practices are permitted to register them under the government’s ‘patient choice’ scheme. However, they are not obliged to do so.
Do I need to ask for the patient’s ID at registration?
Practices are not required to ask for the patients ID upon registration. However, practices can choose to implement a policy whereby they ask for patient ID as part of the registration process. Such a policy must explain the procedure in place for patients who are unable to supply identification, and any such policy must apply to all prospective patients equally. Where patients are unable to provide ID this shouldn’t affect whether you register a patient.
Can I decline to register a patient?
GPs have limited discretion to decline to register patients. A GP can only refuse to register a patient if their list is closed to new patients, if the patient lives outside the practice boundary, or if other reasonable grounds for the refusal exist.
In the event that a practice does refuse a patient’s application, NHS England states that the practice is obliged to record the name, date and reason for the refusal. The practice must give the patient a written explanation of the refusal within 14 days.
Is deciding not to register a patient purely because of their status as an overseas visitor discriminatory?
Yes – all applications for registration must be considered in the same way. The prospective patient’s country of residence is irrelevant to the application process.
Refugees and Asylum Seekers registering at your practice
Please see our webpage Refugees and Asylum Seekers
What if I suspect a patient of fraud?
If there is a suspicion that a patient is committing fraud, by using a fake address for example to try to obtain treatment, GPs ought nevertheless to register and treat the patient. However, GPs must refer the matter to their local NHS counter-fraud specialist or report the matter at www.reportnhsfraud.nhs.uk