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GP mythbuster 36: Registration and treatment of asylum seekers, refugees and other migrants

Categories:
  • Organisations we regulate

When we inspect

When we inspect general practices, we look at how they provide care to different groups of people.

One of these groups is ‘people whose circumstances may make them vulnerable’. This may include asylum seekers, refugees and other vulnerable migrants. The Refugee Council have produced an explanation of refugee terminology).

The issues

Asylum seekers, refugees and migrants face many of the same health problems as the UK population.

They may:

  • have poor awareness of the NHS and fear barriers to accessing treatment
  • come from countries of origin with poor healthcare
  • suffer health impacts (mental and physical) after leaving their country and being detained in the UK
  • have experienced war, conflict or torture
  • be separated from family, have poor housing and be socially isolated.

Some refugees, asylum seekers and migrants incorrectly believe they are not entitled to free treatment. Some practices may think individuals are not entitled to free NHS services.

Services that are free for everyone

This information is from Guidance on implementing the overseas visitor charging regulations (Department of Health and Social Care).

  • treatment for COVID-19
  • free testing and free treatment for paediatric multisystem inflammatory syndrome (that results from COVID-19). 
  • vaccination against COVID-19.

Primary care such as:

  • GP services
  • primary dental and ophthalmic treatment
  • accident and emergency (A&E) services
  • family planning services (not including termination of pregnancy)
  • diagnosis and treatment of specified infectious diseases
  • diagnosis and treatment of sexually transmitted infections
  • palliative care from a registered palliative care charity or a community interest company
  • NHS 111 telephone advice line treatment for a physical or mental condition caused by:
    • torture
    • female genital mutilation
    • domestic violence
    • sexual violence

unless the overseas visitor has travelled to the UK to seek that treatment.

Right to treatment and services

People who are not ‘ordinarily resident’ may be charged for some NHS services.

NHS (Charges to Overseas Visitors) Regulations 2015 apply to all courses of treatment commenced on or after 6 April 2015. Updated regulations were published in 2017.

People exempt from all overseas visitor charges

This information is from Guidance on implementing the overseas visitor charging regulations (Department of Health and Social Care).

In addition to the services above, some overseas visitors are also exempt from the charges which would otherwise apply to overseas visitors:

  • refugees and their dependents
  • asylum seekers and their dependents
  • individuals receiving support from the Home Office. This is under section 95 of the Immigration and Asylum Act 1999 (the 1999 Act)
  • those whose application for asylum was rejected, but they are supported:
    • by the Home Office under section 4(2) of the Immigration and Asylum Act 1999
    • under Part 1 (care and support) of the Care Act 2014
  • children looked after by a local authority
  • victims, and suspected victims, of modern slavery or human trafficking, (determined by the UK Human Trafficking Centre or the Home Office) and their dependents provided they are lawfully present in the UK
  • those receiving compulsory treatment under a court order, or who are liable to be detained in an NHS hospital or deprived of their liberty
  • prisoners and immigration detainees.

People covered by reciprocal healthcare agreements, such as the European Health Insurance Card or who have paid the immigration health surcharge may also be exempt from payment. NHS Choices provides information on how to access NHS services in England if you're visiting from abroad. Gov.uk provides guidance on overseas visitors hospital charging regulations 2017.

Responsibilities of GP practices

Practices have a contractual duty to provide emergency and immediately necessary treatment. This is free of charge for everyone. They:

  • cannot refuse to register someone because of:
    • any ‘protected characteristic’ under the Equality Act 2010
    • other grounds such as social class, appearance or medical condition (NHS constitution)
  • should register patients without requiring any documentation. Overseas visitors do not need to provide proof of identity or immigration status. Asylum seekers may have an ‘application registration card’ (ARC) from Immigration Services.
  • can register asylum seekers and refugees who are not in permanent housing. This is as a temporary patient for up to three months.

Practices should fulfil the fundamental standards of patient equality:

GP practices should always refer overseas visitors where a referral is clinically appropriate. Even if a charge will apply for treatment following a referral, it should still be made. A clinician in secondary care can decide if treatment is urgent, and should be provided before payment. GP practices may wish to make patients aware that they may be charged for treatment for which they are referred.  Importantly, GP practices should tell secondary care services when referring if a patient is exempt and should not be charged.

More information

Last updated:
29 April 2021