| Chapter
6: Management and Clinical Responsibilities |
Statutory/ Manual
References |
| Training |
|
| 1. Stage 1 and 2 officers should
be given training on their respective roles in terms of the statutory position and on the
guidance contained within this Manual. Steps should be taken to ensure that doctors,
dentists and nurses have access to and are familiar with the provisions in this Manual. |
|
| "Stage 1 and 2"
Officers |
|
| 2. Officers should identify
patients liable to NHS charge before they see the consultant. In some cases
identification may be unavoidably but sensibly delayed. However, every effort should be
made to clarify their status in the UK with them as soon as possible and when it has been
assessed as clinically appropriate to do so. |
|
| 3. It may be helpful for Stage 1
and Stage 2 officers to have ready access to the flow-charts and maps attached at Appendix
F1-F6 to show those countries currently on the EEA and reciprocal health care agreement
lists (see Chapters 12 and 13). The maps may also be of assistance to overseas visitors as
an aid to identification of the country of origin in cases where a language or
interpretation difficulty occurs. |
Appendix F5
& F6 |
| HBs, NHS Trusts and DMUs |
|
| 4. NHS hospital managers should
ensure that staff are aware of the rules regarding overseas patients and that: |
|
|
i. effective Stage 1 procedures are in place along the
lines set out in Chapter 8;
|
Chapter 8 |
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ii. effective Stage 2 procedures are in place along the
lines set out in Chapter 9;
|
Chapter 9 |
|
iii. all other staff know they must not
advise patients of their liability, or otherwise, to NHS charges. The decision is for
Stage 1 and 2 officers to make (on the basis of all available evidence), involving
senior/clinical staff, if appropriate; and
|
|
|
iv. the Director of Finance has agreed arrangements for the
presentation of accounts.
|
Chapter 7 |
| Primary Care Services |
|
| 5. For the purposes of primary
care services visitors from EEA member states and reciprocal health care agreement
countries are eligible for NHS "treatment the need for which arose during their
visit". |
Sched 1 1995 Regs Chapter 12 & 13 |
|
i. NHS treatment: GPs referring
overseas visitors to hospital for care should advise them that unless they qualify for
exemption under the EEA member state or reciprocal health care agreements they may face
NHS charges for treatment. Where appropriate, GPs should also alert the
hospital to which the patient is being referred that NHS charges will possibly be
appropriate.
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|
|
ii. Private treatment: Overseas visitors may
wish private care. GP’s are advised, however, to ensure that patients fully
understand whether they are being treated on a private basis, or otherwise.
|
|
| 6. GP’s should also ensure
that overseas visitors from EEA member states or reciprocal health care agreement
countries are aware of their entitlements as described in paragraph 5i above. |
|
| 7. Subject to the above there is
nothing to prevent GPs offering private treatment to overseas visitors. In doing so GPs
must apply the terms of NHS Circular 1981(GEN)7 in connection with the use of health
service premises for the purposes of private practice. |
NHS Circular 1981 (GEN) 7 |
| Note: 1
GP practices with contracts to provide medical attention to overseas visitors in named
hotels or similar residential establishments must ensure that all patients are aware that
the care to be provided may be on a private charged basis depending on the condition
requiring treatment. 2 GP practices may find it helpful to adopt the
questionnaires, flow-charts and maps at Appendix F(1-6) used by hospitals (and referred to
in paragraph 3) to determine an overseas visitors eligibility, or otherwise, to exemption
from NHS charges. |
Appendix F1 - F6
|
| Oxygen Therapy |
|
| 8. For specific guidance on
overseas visitors coming to the UK who require oxygen therapy consult Chapter 12. |
Chapter 12 |
| Hospital Consultants |
|
| 9. Consultants using procedures
agreed with their hospital management have a responsibility to identify, in writing, the
status of any of their in-patients and out-patients whose treatment has been arranged
directly by them, or in collaboration with colleagues in the UK or overseas. |
|
| 10. Consultation and/or treatment
of overseas patients should follow the hospital’s usual arrangements for
identification and/or admission. It is important that overseas patients, who might be
unable to meet NHS charges or who may have been misled in their own country as to their
statutory requirement to pay, should be given a clear explanation of their position
in this respect. Such action is subject, as always, to a primary concern for the medical
attention they require. |
|
| Infectious Diseases |
|
| 11. A list of infectious diseases
the treatment of which is exempt from NHS charges is provided at Chapter 10. Where a
patient suffering from any of the listed conditions is erroneously facing NHS charges, the
Stage 2 officer must be alerted as soon as possible. |
Chapter 10 |
| "Treatment the need for
which arose during the visit" |
|
| 12. "Treatment the need for
which arose during the visit" means diagnosis of symptoms or signs occurring for the
first time after the visitor's arrival in the UK and any other treatment which, in the
opinion of the clinician employed by, or under contract with, a HB or, as the case may be,
an NHS Trust, is required promptly for a condition which arose after the visitor's arrival
in the UK, or became, or but for treatment would be likely to become, acutely exacerbated
after such arrival. |
Chapter 2 |
| 13. When a clinical opinion is
required to assist a decision on whether or not a patient should be subject
to NHS charges, the Stage 2 officer should ask for the doctor’s or
dentist’s written advice using the form provided at Appendix C. If a patient who is
to have a Stage 2 interview happens to be seen by a doctor or dentist first, the Stage 1
officer may also ask for a clinical opinion. When a clinical opinion cannot
be obtained the patient should be given the benefit of the doubt, until such time as the
position is clarified. |
Appendix C |
