29 December 2013
Last updated at 19:56 ET
Migrants and overseas visitors are to face new charges for some NHS services in England, ministers say.
They include extended prescription fees, the introduction of charges for some emergency care and higher rates for optical and dental services.
However, GP and nurse consultations will remain free, and nobody will be turned away in an emergency.
Ministers say they are keen to clamp down on any abuse of the system, but doctors’ leaders have voiced concerns.
The government had considered charging for GP consultations, but decided that easy initial access was important to prevent risks to public health such as HIV, TB and sexually transmitted infections.
Other types of primary care services that are being considered for charging include minor surgery that is carried out by a GP and physiotherapy that has been referred through a GP.
There are also plans to introduce a new system for identifying and recording patients who should be charged for NHS services.
Specific details of how the plans will be implemented are due to be unveiled in March 2014.
The government said the changes would allow the NHS to recoup money, and encourage only those who need urgent and emergency care to attend.
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 hardworking 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.”
A report by the King’s Fund think tank has estimated that an average attendance at AE costs the NHS approximately £111.
The British Medical Association said it was concerned the proposals would require doctors and GPs to spend more time on paperwork and that it could cost more in administration charges than what it would recuperate.
Dr Mark Porter, chairman of the BMA Council, said: “The government’s current proposals could create unintended drawbacks for the NHS and patients.
“They are likely to create a complex patchwork of charging and access entitlements where some services remain free, such as GP appointments, while others will be chargeable, including AE visits and other services provided via many GP practices, such as physiotherapy.”
Dr Chaand Nagpaul, who leads the BMA’s GP committee, added: “We cannot have a situation where any patient with a serious health need is deterred from visiting a GP, especially if their condition raises a potential public health risk.”
Labour shadow health minister Lord Hunt accused ministers of “putting spin before substance”.
“Labour is in favour of improving the recovery of costs from people with no entitlement to NHS treatment,” he said.
“Rather than more grand-standing, 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.”
The announcement follows a Department of Health study which estimated that up to £500m could be recovered from overseas visitors’ and migrants’ use of the NHS every year through better charging. However, it estimated that only approximately £8m would come from charges for using AE.
However, academics have argued that the extent of deliberate health tourism – where people travel to the UK specifically to use the NHS – has been hugely overstated and is responsible for only a small part of NHS expenditure.
The government has already announced a £200-a-year levy on migrants from outside the European Economic Area staying for between six months and five years.
A cost-recovery unit will help hospitals claw back money they are owed by other governments for treating foreign nationals visiting the UK.