Published: 08/01/2004, Volume II4, No. 5886 Page 3

The government is considering proposals to introduce charges for overseas patients using primary care services - but not until 2007, three years after the controversial scheme for hospitals is due to be introduced.

The recommendation to health minister John Hutton was made at the end of November in a Department of Health document obtained by HSJ. Late last month, Mr Hutton announced that hospital charges for overseas visitors would be implemented from April.

The paper, by DoH director of access Margaret Edwards and director of finance Richard Douglas, provides an update of progress in response to ministerial requests to work up charging proposals for primary care, similar to those in hospitals.

But the authors warn that an equivalent scheme should be introduced more slowly in primary care - because of fears of administrative problems and rejection of the idea by GP leaders.

In a letter to Mr Hutton, they suggest implementation takes place in 2007 to coincide with the government's proposed introduction of ID cards. Obtaining evidence of an overseas person's right to be treated by the NHS without charge caused particular concern to trusts in the DoH's consultation on hospital charges, details of which were published last month.

ID cards would provide one solution to this. The document also warns that earlier implementation could cause rifts with the British Medical Association.

The document says: 'ID cards are due to be phased in from 2007. The options are to link the introduction of charges to that date or to go for an earlier date.

'Given the resource issues, primary care trusts' capacity and their existing agenda (eg, out of hours) and potential handling issues with the BMA - where risks increase with earlier timing - we recommend working towards implementation for 2007.'

The document admits: 'We have no firm figures on the number of overseas visitors accessing free care or the cost of treatment.' Noting estimates that 'some£15m would be recoverable though charges', the authors warn 'this may underestimate the likely impact of bad debts and recovery costs'.

It adds: 'These uncertainties reinforce the imperative of linking implementation to ID cards.'

But Ms Edwards and Mr Douglas go on to say the upfront costs of introducing the new policy - plus an allowance for unrecovered charges - 'could be met only by adjusting the financial envelope for the new [general medical services] contract and [personal medical services].'

Warning that 'this would be rejected by the BMA and its membership', they go on to recommend a charged system is developed outside GMS and PMS.

The paper adds: 'This would simplify the new service and avoid chargeable patients corrupting practice lists and [quality and outcomes framework] payments.

Recovered charges would then be PCT income.'

Commenting on the paper, NHS Alliance chief executive Mike Sobanja said: 'I do not really see why it would have to wait until 2007. Rather than make it a separate service, I would like to see it included in the contract.'

A DoH spokesperson said: 'We do not comment on leaked papers.

In any case, no decision has been taken and any changes to regulations would have to be subject to consultation.'