title: Charging systems for migrants in primary care: the experiences of family doctors in a high-migrant area of London.
abstract: BACKGROUND
  There is speculation that a high number of migrants use free UK National Health Services to which they are not entitled. In response, the UK government has sought to develop and expand current overseas visitors (OVs) charging systems to target these noneligible migrants for payment. Current guidance to UK primary care providers is ambiguous, and little is known about existing procedures for dealing with new migrants. We aimed to explore the impact of OVs on primary care services and to assess the views of health-care providers about current charging systems.
  
  
  METHODS
  We undertook a 23-point semistructured questionnaire survey of family doctors working within a high-migrant area of London. Outcome measures were the following: the impact of OVs on their practices, current procedures for registering this patient group, and doctors' concerns around expanding existing charging systems.
  
  
  RESULTS
  Ninety-two doctors from 53 practices completed the survey (practice response rate 82.8%). Fifty-one (55.4%) of the 92 doctors reported having systems in place to identify and charge OVs requesting registration, and follow-up procedures differed across practices. Significantly more doctors [65 (70.7%)] reported not having any OVs on their practice lists receiving free consultations (p < 0.001; 298 OVs reported in total). Of the 24 (26.1%) doctors who did, this equated to approximately pound3,000 monthly lost income in total for uncharged consultations across all the practices within the survey site. Seventy-eight (84.8%) doctors want a better system to identify and charge OVs in primary care but question the workability of proposals to streamline charging procedures across primary and secondary care. Concerns were raised about the implications for migrants unable to access appropriate health care and the impact on public health priorities.
  
  
  CONCLUSIONS
  We identified variations in current procedures for identifying and registering OVs, which may result in the inappropriate exclusion of new migrants from free primary care services in the UK. Our findings suggest that the number of OVs receiving free primary care services is low. We need to explore models of appropriate health-care delivery to new migrants in the UK context, drawing on models of best practice from established health services in other migrant-receiving countries.
authors.affiliation: International Health Unit, Department of Infectious Diseases and Immunity, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Hargreaves
authors.forename: Alison H
authors.initials: AH
authors.lastname: Holmes
authors.forename: Sonia
authors.initials: S
authors.lastname: Saxena
authors.forename: Peter
authors.initials: P
authors.lastname: Le Feuvre
authors.forename: Wayne
authors.initials: W
authors.lastname: Farah
authors.forename: Ghias
authors.initials: G
authors.lastname: Shafi
authors.forename: Jehanzeb
authors.initials: J
authors.lastname: Chaudry
authors.forename: Hamed
authors.initials: H
authors.lastname: Khan
authors.forename: Jon S
authors.initials: JS
authors.lastname: Friedland
mesh_terms: D001291:Attitude of Health Personnel; D004608:Eligibility Determination; D054242:Emigrants and Immigrants; D005194:Family Practice / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008131:London; D010350:Patient Credit and Collection; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D013222:State Medicine / Q000191:economics*; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000191:economics* / Q000706:statistics & numerical data