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Nigel's surgery 36: Registration and treatment of asylum seekers, refugees and other migrants

  • Organisations we regulate

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 (see an explanation of refugee terminology).

The issues

Asylum seekers, refugees and migrants face many of the same health problems as the UK population. In addition, 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, while some practices may think individuals are not entitled to free NHS services.

Right to treatment and services

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

The National Health Service (Charges to Overseas Visitors) Regulations 2015 (the Charging Regulations) apply to all courses of treatment commenced on or after 6 April 2015.  The regulations were updated in 2017.

Services that are free for everyone:

(This information is taken from page 12, ‘Guidance on implementing the overseas visitor charging regulations’ (Department of Health and Social Care).)

  • 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
  • NHS111 telephone advice line
  • treatment for a physical or mental condition caused by (unless the overseas visitor has travelled to the UK for the purpose of seeking that treatment):
    • torture
    • female genital mutilation
    • domestic violence, or
    • sexual violence

People exempt from all overseas visitor charges:

(This information is taken from pages 12 to 15, Guidance on implementing the overseas visitor charging regulations’ (Department of Health and Social Care).)

In addition to the services above, some overseas visitors (listed below) 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 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. See NHS Choices and Guidance on overseas visitors hospital charging regulations 2017.

Responsibilities of GP practices

Practices have a contractual duty to provide emergency and immediately necessary treatment 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; although asylum seekers may have an ‘application registration card’ (ARC) from Immigration Services.
  • Can register asylum seekers and refugees who are not in permanent housing as a temporary patient for up to three months.

Practices should also fulfil the fundamental standards relating to patient equality:

  • Regulation 10 – treating people with dignity and respect
  • Regulation 13 – protecting people from abuse and improper treatment

GP practices should always refer overseas visitors where a referral is clinically appropriate. Even if a charge will apply for treatment following a referral, the referral should still be made, so that a clinician in secondary care can decide if treatment is urgent, and therefore should be provided in advance of payment. GP practices may wish to make patients aware that they may be charged for treatment for which they are referred.

More information

Public Health England: online migrant health guide, covering entitlements and other health issues

NHS England: guide to reducing inequalities in access to general practice

NHS Choices: information for the public on their rights to register with a GP – including a leaflet specifically for refugees and asylum seekers

Last updated:
20 June 2019