Doctors should not be made to act as 'border guards' for migrant patients, say medical leaders

GPs have come under pressure to identify patients who should be charged

Doctors should play no part in monitoring a patient’s immigration status, medical leaders have said, amid reports of GPs being forced to act like “border guards” as a result of the Government’s crackdown on so-called health tourism.

While GP services remain free to all, regardless of immigration status, many practices have come under increasing pressure to identify patients who should be charged, one family doctor said.

Doctors’ union the British Medical Association (BMA) will decide on Wednesday whether to back a call from medics in London and Manchester, which could see BMA members advised “not to partake in any process of monitoring or deciding upon a patient’s migration status.”

The motion, to be debated at the BMA’s annual congress in Liverpool, says GPs are “now being asked to undertake the work of immigration officers in checking people’s right to receive NHS care.

New health charges for non-UK residents were introduced in April, which the Government predict could raise £500m for the NHS.

GP surgeries do not charge anyone for care, but may have to refer a chargeable patient for hospital services that may come with a fee.

Dr Elliott Singer, GP in Waltham Forest, a medical director of the London-wide Local Medical Committees (LMCs), said that this could put GPs in an “awful” position, when referring patients, often with little income, who are not eligible for free hospital care.

“NHS Trusts are definitely trying to ensure that they are getting funding for the people they treat,” he said.

“In areas with high migrant populations this is a real issue and clinicians are having ethical discussions about what should we be providing – it splits the profession.

“Should we be putting [the fact they are chargeable] in their patient’s letter? Ethically it puts us in an awful, awful position and I don’t think it’s our job to be doing that.”

Dr Mark Porter, chair of the BMA, has previously asserted that “anyone accessing NHS services should be eligible to do so, but a doctor's duty is to treat the patient that's in front on them, not to act as border guard.”

The new motion, which has been submitted by doctors from Tower Hamlets, Manchester and Salford, and Dr Singer’s Waltham Forest LMC, calls on the BMA to “provide unequivocal support for any doctor who is vicitmised for refusing to partake in monitoring of immigration status” and to agree with other unions on “cohesive guidance to all NHS staff advising them not to partake in any process of monitoring of deciding upon a patient’s migration status”.

Phil Murwill, UK programme officer for Doctors of the World, which provides support for vulnerable migrants who cannot afford NHS fees, backed the motion and said that many people were already “too afraid to access care” from GPs.

“Vulnerable migrants are already put off accessing key services due to fears that they will be asked question about their immigration status, sometimes with tragic results,” he said. “GPs also play a vital role in screening for infectious diseases and dissuading people from accessing such services makes no sense at all.”

Dr Richard Vautrey, deputy chair of the BMA’s GP committee, said that the pressure to find out a patient’s immigration status could place a heavy burden on already over-stretched GP staff.

“We are there to defend and support doctors. If doctors are being pressured to do something that is an inappropriate task and they have ethical or moral concerns about what they are being asked to do then the BMA will stand four-square behind them.

“We want to make sure that doctors can doctor, and it’s for others to decide how the necessary funding for the service is secured.”

A Department of Health spokesperson said: “We have absolutely no intention for doctors and nurses to take on an immigration role.

“With the NHS busier than ever, getting NHS managers to recoup visitors’ costs will help keep services sustainable.”