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Should GPs charge overseas patients for care?
Dr Russell Brown argues that GPs need funding for treating overseas visitors, but Dr Jackie Applebee argues this will rock the foundations of the NHS for little benefit
These overseas visitors are patients like any other, and so we should be paid for treating them. This is not about making a political point, this is not about GP surgeries policing eligibility for NHS care, this is not about denying care, it is about proper resourcing of work which is currently unfunded.
In Eastbourne we have many young foreign students, visiting for a few weeks, some of whom need to see a GP. Many of them are from countries with no reciprocal arrangements for healthcare. Even if there are arrangements in place, that funding doesn't reach us. But if they apply to join our lists, we are obliged to see them, for no extra funding. This is not in the global sum: there have been no adjustments to the global sum made for temporary residents since 2004.
Why? If visiting the UK, is it unreasonable to expect them to have adequate travel insurance, as we would when going abroad? It's not hard to arrange and it would simplify matters considerably. Then there would be no burden on the UK taxpayer to support people from outside the UK who seek access to a GP. The Government recognised this cost to the public purse in the recent Queen's speech. A bill is to be enacted to allow charging, but the Government consultation on this only concerns charging in A&E. If it is going to happen, it needs to happen in general practice too or we will potentially be inundated.
This doesn't need to have an impact on public health issues. If there is a person seeking care for tuberculosis for example there are already services in place to deal with it.
So if we assume that these patients will need to fund or resource their care, who should take the money? Well, given this is work happening in our practices, why should we not use that money to provide the service? And that being the case, why should we not collect the money ourselves? This would move any need for a complex claiming process, with annual uplifts and clawbacks, reconciliations, audits etc. We already take money for things like HGV medicals. It isn't difficult or ethically dubious.
Some argue that this would be too much administration for our practices. However, EU citizens would expect to show a European Health Insurance Card. Visitors from elsewhere will be used to providing insurance details. This would not be a problem.
Importantly, collecting fees in this way is not removing resource from our NHS patients. Don't forget opportunity costs: if a GP is seeing a foreign visitor, that is time they cannot devote to their NHS patients or to tasks necessary to the running of a busy general practice.
And if this is unpalatable to the Government or others there is already a multitude of services which could care for these patients including walk-in centres and A&E departments. So if there is no wish to fund activity in general practice, it should be directed elsewhere. We are busy enough already.
Dr Russell Brown is Chair of East Sussex LMC, co-founder of Resilient GP and a GP in East Sussex. He proposed the motion in favour of charging overseas patients at the LMCs conference in May.
Charging overseas visitors for care will endanger the fundamental principles of the NHS, that care is free at the point of delivery, for almost no financial benefit to us as GPs.
How much money would charging overseas visitors actually bring in? Would it even cover the costs of the extra administrative burden that this policy would place on our already overstretched reception staff? Reception staff who would have to police all patients coming to the practice to check whether they would be eligible for free care.
Previous LMCs conferences have voted overwhelmingly to reject GP practices becoming outposts of the UK Border Agency. It is disappointing that this year, a motion was passed in favour of charging overseas visitors for GP care. However it must be said that the hall was half empty because many delegates had gone for a break after a long and emotional debate on the response to the crisis in general practice.
During this debate, speaker after speaker described desperate situations, some were moved to tears. The message was unambiguous. General practice is dying, and has received a decreasing proportion of an increasingly squeezed NHS budget for far too long. The GP Forward View promises too little too late for most of us. I have no doubt that those in favour of charging overseas visitors feel overwhelmed and wish to do all they can to cut their workload. However, we are in crisis because the Government underinvests in the NHS, not because foreign visitors get free primary care.
Research tells us that migrants are a net benefit to the economy. Overall, even if they do get free general practice care, they contribute more in taxes than they receive from benefits and public services.
A lot of overseas visitors are poor and charges will stop many consulting about their health problems. Even those who object to foreigners getting free GP care must agree that it is in none of our interests for people to be in the community with untreated infectious diseases.
The Commonwealth Fund repeatedly reports that the NHS is the most cost effective health care system in the developed world yet the Government constantly complains that the NHS is unsustainable. Moves to charge overseas patients plays into their hands. Once the mechanisms are in place to charge overseas visitors it is a smaller step to charging everybody.
The NHS was set up to be free at the point of delivery, publicly funded and publicly provided. It is the envy of the world and the most popular institution in Britain. General practice is the jewel in its crown. I believe that bringing in charges for foreign visitors will rock these vital foundations for very little, if any, financial benefit.
Dr Jackie Applebee is chair of Tower Hamlets LMC and a GP in east London
Readers' comments (22)
Jackie, one of the main reasons that 'General Practice is dying' as you put it, is because we are trying to squeeze the last drops of blood from a dried out husk. Your altruism is very laudable I'm sure but is misguided. By failing to charge we encourage health tourism and deny resources to our own registered patients. Foreign students on exchange visits are not poor and should (do) have travel insurance. If I travel to Australia or Canada I am not expecting the residents of those countries to pick up the bill if I fall sick while I'm there.
Jackie Applebee's argument is seriously flawed.
1. Until not long ago practices did charge overseas visitors under the basic rule that we treated UK residents. Residency is a complex legal issue but it simplified down to – is the person here for a settled purpose of 6 months or more? If not, do they need "emergency" treatment which we would give for free. Otherwise we charged £30 per 10 minutes and not a single visitor complained, almost all expected to pay before we even told them, and many were surprised it was so cheap.
2. A handful of years ago the Government changed the rule to a more complex flow chart depending on country of origin, but we still charged plenty, such as American visitors, and they expected to pay.
3. It was only recently that this hopeless Government allegedly wanting to stop health tourism changed the rule yet again to make general practice give treatment for free! REALLY FREE. Not just paid for by the taxpayer and free at the point of abuse, but since the practice gets no income the GPs and nurses and reception staff are working for nothing.
4. Her argument centres on the NHS founding principle of free for all. When Bevan started the NHS he never envisaged tourism on the scale that it is now, or the possibility of tourism purely to get free healthcare. Bevan will be turning in his grave at the thought of the poor working class tax payers paying their precious little money to buy healthcare for foreigners.
5. Since Dr Applebee approves of free for all, at what level would she say it cannot go on? When 1/3 of a practice's work is tourists, unfunded by the NHS? ½ of a practice's work? Her premise is bonkers, the UK taxpayer cannot fun a healthcare system that is free for anyone in the world to come and use.
6. She says it is difficult and costly to police. Certainly not true in our experience when we used to charge, most people from overseas are expecting to pay and declare themselves right at the start, if they try to deceive us then they don't match to the spine, we need to know more details from them, sure some will slip through and get treated free but others will be discovered, the majority of visitors get charged for little extra effort.
7. How does Dr Applebee explain every other country in the world managing to charge yet somehow we would find it too cumbersome, too costly?
8. How does she explain that only in the UK would practices be the "border police" yet no other country on the entire planet thinks that?
Frankly Dr Applebee, I find your attitude to the poor UK taxpayer, and the overstretched NHS to be deeply troubling and fundamentally wrong.
This comment has been moderated
" It is the envy of the world"
In your dreams Dr Applebee. Please explain why no other country, even socialists' paradises like Sweden, have attempted to copy this system that you claim they envy so much?
If they envy it, then why did the French Foreign Minister describe the NHS as "medieval" a few years ago? Why did France issue official guidance to French tourists coming to Britain that if they fell ill they should go private immediately and avoid the NHS?
Envy? laughing stock more like.
This comment has been moderated


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All the judges have turned in their scorecards. Time now to do the tabulating. I'm absolutely sure that we'll announce in the next few days, just don't know which will be the day.
As Stan Lee might've said: "Watch this space, frantic ones."
And, I'd like to add, keep your fingers crossed.


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Well, I must say I have done very poorly at my weekly blog posts lately. My apologies if anyone has been remotely affected by this, but I suspect it is likely only I who have noticed my absence. A philosophical thought for contemplation if I've ever heard one, feeling the absence of oneself.
The explanation lies in my last post where I was marvelling at the effects of excitement, specifically concerning first time home purchasing. Sadly, the house that sparked that tirade fell through, but we are now most of the way through the process on a different house. This process has been exciting, stressful, and very time consuming, even if time has only been consumed by the gnashing teeth of useless fretting while at a standstill in the proceedings. I just keep reminding myself that we are that much closer to our homesteading dreams!
Of course, it's not only house related adventures causing the distraction. Work has picked up as the farming season gets into full swing. There is never a dull moment with beds to weed, vegetables to harvest, seeds to be sown, and deer to thwart. I am just grateful that I do still have some farming in my life as it is an activity that brings me joy, and I am extremely lucky to be enjoying my sixth season on one particular farm which is very special to me.
But that's not all! In case you were wondering where this rambling (and perhaps slightly dull) life update is going, you are about to find out! …In a moment.
At my other place of work, a local food co-op, a friendly health challenge has been proffered. Having been one to accept I am now obligated to spend the next three months building healthier habits, which is great! It just also happens to take time because one of the things you can get points for is how many steps you take in a day, and I'm just not one to let my team down. (We're almost to the point…) One way for a team to win a prize is to have the most posts on social media. Now, I would love to help with this, but… where we are right now, you and I, is the most social media I've got. I've had this grand idea of giving myself a photography challenge (because what I need are more challenges in my life just now) of taking a picture a day somehow related to health and getting it posted… somehow… somewhere. I have a sneaking suspicion that "social media" means Facebook, Instagram, and that sort of thing. Yet here I am, the lowly blogger (and proud of it), wondering if I count.
I point my wordy, un-breakfast related finger at you, Facebook, and declare that I count!
Anyway, here are my pictures so far. I hope to update them more frequently than I have, but it took being rained out of farming to do this today, so we shall see.
(Descriptive, humorous, or simply inane captions are included if you click on the photos.)


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Designed to enable more compact electronic control units for automotive vision systems and other in-vehicle applications, STMicroelectronics' new L5965 contains seven different regulators. These consist of two battery-compatible buck pre-regulators (one of which is a controller), two buck post-regulators with internal compensation, one boost that can be used to supply (e.g., a CAN bus), one LDO, and a 1% accurate reference voltage regulator for the microcontroller. All of the regulators, except for the BUCK 1 pre-regulator, have internal power switches.
With seven regulated outputs, a single L5965 can power an entire camera- or radar-based ADAS system, including the sensors, memory ICs, processor, and CAN interface circuitry.
The part works by leveraging direct operation from battery voltage with register-programmable output voltages and sequencing plus integrated functional-safety mechanisms. Being able to operate directly from the vehicle battery allows the devices to be used without a pre-regulator. Its register-programmable outputs also eliminate voltage-setting resistors, and the on-chip regulators can be used without external compensation circuitry.
This simplified block diagram reveals the key components of ST's L5965 power-management chip.
While reducing both footprint and bill of materials (BOM), these savings in external components also increase system reliability and enhance accuracy by eliminating fluctuation due to environmental effects on external components.
All output voltages can be selected via OTP (One Time Programmable) memory cells that are able to be programmed before using the power-management IC. OTP cells are used for main device parameters and power up phase programming. Through the OTP, it's also possible to decide the switching frequency of some regulator and the current limitation, as well as select the main buck and system power-on sequence. In addition, programming can be done at the customer's production line.
Furthermore, an SPI interface can be used for diagnostic information (e.g., to communicate the status of the bucks in case of fault, over-temperature, or other events) and to program internal block parameters. With this bus, it's possible to set overvoltage and undervoltage thresholds, enable the spread spectrum, select the soft start time, and perform other tasks. The maximum free run switching frequency of the bucks is 2.4 MHz, modifiable through external synchronization signals. The device can manage watchdog and reset signals.
According to STMicroelectronics, the integrated functional safety features are designed in compliance with ISO 26262 and enable systems to fulfill Automotive Safety Integrity Level (ASIL) requirements up to ASIL-D. The mechanisms include a failure status pin, voltage monitors, ground-loss comparators, analog and digital built-in self-test (BIST), and temperature monitors.
STMicroelectronics is ramping up production of the L5965. Samples are available now in a 7- × 7-mm QFN48 package that doesn't require a heatsink.


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The purpose of this report is to provide a simple description of how is human resource management used to identify the most suitable person for a current job position and to evaluate how different methods used during this process contribute to the final assessment of the person in hand. But before that a clear definition what exactly is human resource management should be given. Armstrong(2003) defines human resource management as a strategic and coherent approach to the management of an organization's most valued assets which is the people working there who individually and collectively contribute to the achievement of success. In other words, the aim of human resource management is to satisfy and achieve its objectives effectively by selecting, placing, orienting, evaluating and retaining the right people for the right job at the right time. (Scribd)
Human resource management is an essential issue to all business because once they fail to manage its employees effectively, for example, allocating a wrong people for the job position, they will waste their investment for training their employee and time or even worse, deteriorating their business due to the poor performance of its workforce. As mentioned before, the very first stage of the human resource management is about selection process and recruitment. According to Armstrong (2003), the overall aim of this stage is to obtain at minimum cost the quantity and quality of employees required to satisfy the human resource needs of the organization. In this era of globalization, it is a big issue to identify a suitable person with required skills, competence from a massive labor market for the business to obtain a well and performance in order to counter its large numbers of competitors. In this report, it will be emphasized on the selection process and recruitment, in particular the techniques that were used in the selection process. It will discuss how the business using these common techniques such as job description, testing, interviews in order to find a right person for the job based on a wide range of sources from newspaper, academic journal, book and webpage. -Application form
The Term Paper on Why Do Students Choose Human Resource Management
... of Human Resource Management. Now it is essencial to give a definition of Human Resource Management.Just 20-30 years ago Human Resource Management process ... the Human Resource Managers task is to choose the right person to be promoted. As one can see, Human Resource Management plays ... employees carefully. Then there followes the organization of job interviews and, if necessary, testing of the ...
To commence with, in order to find a right person for a right job in a massive labor market, the most typically selection process is that recruiters begin with a review of the biographic data which is represented in the application forms. It is also known as a pre-selection process which helps the recruiters to sift the most suitable candidates to the short list which is used for subsequent actions such as testing and interview According to Harris (2000), a fair and objective selection process should first list all the job-related requirements for the job based on job analysis by the recruiters and weight those job requirement according to their importance. The recruiters would then use a well-established and standard application form which means that using one application form for all type of jobs rather than using CVs to screen the applicants.
They should help and advice all candidates to describe how they meet the job requirements with relevant examples on the application form. The applicants will provide their demographic details such as age, sex, family etc. but also their "knowledge", "skills" and "experience" in their application form and the recruiters would sift the suitable applicants based on the their essential skills, experience according to the importance for short-listing. Besides, due to the increasing numbers of application, in the recent years, many global companies started to use online application form as their first step to screen their applicants because it is the most effective and efficient way to pick up the potential job seekers they needed. -Test
The Essay on Job Selection
... also offer the opportunity of promotion for those whose former job restricts their development. However, there are also downsides for the ... . Because of the same job for the same company, employees are quite familiar with their ... viewpoint has its advantages. To the former one, the constant job can provide people stability, which will stimulate them work harder ...
Human resource management (HRM) looks at how to use business personnel successfully and it relates to events unite with the management work and staffs. One main area of human resource management is human resource flow, which involves recruitment, selection, training, development and deployment. Recruitment and selection is the most pivotal step used to find the right person for the job. Recruitment and selection is the process of generating qualified applicants and select promising ones. Personality test is a good method for selection, because it makes experts to know applicants' working performance. "Personality tests should be introduced to ensure that teachers with poor social skills do not make it into the classroom, a Scottish government-commissioned report says." (Lindsay McIntosh,2011, ) Personality test refers to attributes under standardized conditions. However, disparate personalities may bring the same good working performance.
"According to Rob Yeung, business psychologist and senior consultant at Kiddy & Partners, personality tests have their limitations." ( Hilary Freeman, 2001)Clever and creative staffs must have different tendencies and hobbies. "If you have a group of people who are all the same it will limit an organisation. If everybody's an innovator, nothing will ever get done. Organisations need to recruit a mix of personalities." ( Hilary Freeman, 2001) Nowadays, human resource management (HRM) never forgets to use testing as a selection technique. What a test basically is trying to establish, is a fraction of the person's behaviour. There are two fundamental concepts related to testing- reliability and validity. "A reliable test is one that yields consistent scores when a person takes two alternate forms of the test or when he or she takes the same test on two or more different occasions", while validity proves that the test is useful, it ensures us that the test is accurate and measures what we intend to measure.
The Term Paper on Online Recruiting And Employee Selection Tests
... selection tests such as II. Types of Selection Exams There are several selection tests that employers give to potential candidates ... follow up by contacting candidates for interviews. Job recruiting over the Internet allows candidates and corporations a chance ... person for the job." "For job seekers handwriting analysis provides an added bonus in that it requires no painful or embarrassing interview ...
Now it's turn to work sampling. Basically, work sampling is a sample of several tasks essential to the job. The aim of work sampling technique is to measure the applicant's level of work performance directly. It's advantages over the other selection methods are that it's highly accurate. Its questions are reliable and related to the actual job. Answers cannot be simulated or faked and last but not least, this selection method is acceptable and fair to women and minorities. There is no chance of invasion into privacy.
However, On the other hand there are Assessment Centres (ACs).
ACs are probably the most thorough and sophisticated selection method. It's a comprehensive procedure of two-to-three day simulation in which a combination of different assessment techniques (ACs use group, individual and written exercises) is used to determine the potential and the skills of a group of candidates. Observations are conducted by managers and even psychologists. While the assessment centre is viewed as highly reliable and effective multi-trait assessment method, its cost is high. Nevertheless many researches have proven that it's worth it.
Another method not to be neglected is Video-based situational testing. What AC, work sampling and video-based situational testing have in common is that they are all situational tests. They all refer to hypothetical situations of the job. The difference is now video-based simulations are presented to the candidates mostly on PCs (personal computers) or other type of console. When the simulation is over the participants should answer to multiple questions or to choose from several courses of action. Validity and reliability are again high on the scale.
Finally, A method mainly used by large manufacturers takes its place- The Miniature Job Training & Evaluation Approach (MJTEA)- is a process of training probable employees to several job tasks prior to the actual employment. This approach suggests that participants who are able to lean and perform some aspects of the job will show good results in mastering the job itself. Since its absolutely related to the job its relevant and valid but sometimes expensive as well. Interview
The Term Paper on Data Base Job Candidate Company
... desktop publishing After the interview process the candidate has to show a past job sample. Then the candidate can display their ability ... these people have hands on experience. During the selection process, all candidates need to submit a resume and fill the ... these people have hands on experience. During the selection process, all candidates need to submit a resume and fill the application ...
The interview is a face-to-face chance between the interviewer and interviewee to observe, converse and collect the relevant information of the interviewee. Thus to understand the personal qualities and ability condition of the interviewee. In addition, the interview is the most effective way to find a right person for the job. Because the interviewer can learn the state of interviewee directly, for example, the educational background of the interviewee, the previous work experience, the personality characteristics, the social activities as well. During the interview, the interviewer can judge the flexibility and psychological qualities of the interviewee, thereby exploring their potential and confirming whether the interviewer can do this job. However, interview is not the only way to find a right person for the job, the human resource also can through some other approaches for recruitment.
For example, the application form, academic text and so on. The importance of ensuring the selection of the right person to join the workforce has become increasingly apparent as the emphasis on people as the prime source of competitive advantage has grown. (Beardwell and Claydon, 2010).
That is to say, Interview is the most important step of the human resource management used of find the right person. The interviewer has to decide which of the candidates is going to be most suited to the job. So interviewees must be prepared for the interview. The better prepared you are, the better your chances of winning the job. Furthermore, when the interviewer ask you questions, making sure you speak clearly, and answer questions without mumbling. Good body language and eye contact as well. Don't interrupt the interviewer. (Jay, 2005).
-Other selection
As mentioned earlier application forms, testing and interview are selection devices. In addition to this there are two other crucial requisite selection techniques for human resources management, to help find the right person for the job. These techniques are reference checking and health exams, both help in the staffing decisions. Before making any imprudent decisions on a single candidate, there's one important step you need to take—check the reference. Most of the time, on the basis of written references to judge a candidate whether appropriate for a position may have some defects; perhaps someone wants rid of an employee,they certainly won't give a poor reference under those circumstances, candidates that overplay their skills can often be revealed during this process. Therefore, reference checking allows employers to check up information hand over by the candidate. This is to ensure that the candidates` reference is true or not. However, "obtaining information about potential candidates is often difficult because of privacy laws and employer concerns about defamation lawsuits."(cliffsnotes)
The Essay on How to Prepare for Job Interview
... in proving his/her abilities to the interviewer. While preparing for a job interview, an individual should attempt to present him ... aspirant in facing the interview with confidence. The interviewer may look for specific knowledge while interviewing a candidate for employing in the ... applied is an important part of preparation for a job interview. The interviewee should also ensure that his/her dressing ...
Health exams is another selection techniques require to take into consider. Identify health problems, as well as detecting diseases that may be unknown to the applicant may increase the absenteeism and accidents level or decrease the level of work efficiency. Thus, In order to positive development company in the future, human resource management will more care about the state of health of candidates during the selection. Employing the candidate who in good physical condition, not only will to improve organizational performance and productivity but also to help to strengthen the cohesion of the enterprise, promote the sustainable development of enterprise as well.
Cliffsnotes. Selecting the Best Person for the Job. [online] Available at: < //www.cliffsnotes.com/study_guide/Selecting-the-Best-Person-for-the-Job.a


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Posts tagged solid wood floors London
Flooring London
Aug 6th
Posted by Wordpressb3 in About Jetshare
Wood floors are made of floorboards or parquet create a special atmosphere of our house. We offer professional services as solid wood flooring london is the area of our business. The floor is one of the most exploited elements, space, which is why it is often damaged, chafed. The floor must be appropriately prepared, so do the scraping, is a multi-step process, and must be done appropriately. Therefore, such services should be outsourced to specialists. The floor must be very durable and resistant to abrasion, therefore the wood used for production must be of the best quality. Floors can be uniform color or have a variety of colors and grains that enhance the elegance of the floor. We are renovating old wooden floors.