NHS tourism: not as simple as you thought

Every GP, and every casualty officer in Britain is familiar with the phenomenon of foreign nationals attempting to obtain medical services free at the point of delivery, as is the custom in our greatest institution: the National Health Service. And it can be exceedingly difficult to tell the legitimate from the less so. And as a spokesman for the BMA said this morning, it isn't a doctor's job to act as unpaid UK border officials. Most doctor's instincts are to treat the patient in front of them without checking their credit rating, as is the custom throughout the United States. But we do try.

Asylum seekers are entitled to free treatment, so if they tell us they are, usually we don't ask any further questions. Similarly, any EU resident is also entitled to free treatment, as well as non-EU residents who have been resident in the UK for more than six months. So we depend on people's honesty to a very large extent. If visitors arrive from distant shores, however, my practice is immediately to inform them that my work for them will require a fee (I usually charge £20 per consultation; sometimes more, depending on how rich they look), and also warn them that any tests or hospital referrals I may see fit to arrange will also attract a fee. Most cough up uncomplainingly, especially the yanks, who can't believe what a bargain they are getting compared with home. But some are less happy.

The other day I had a family of very well heeled visitors from Singapore arrive at the practice in a hired 7 series BMW, all five of them dressed in designer clothes and all requiring some sort of medical intervention. On being told they would have to pay (as they do at home) the parents flew into a rage and stormed out of the surgery, but not before accusing me of being "racist scum"..

This is the sort of NHS tourism we should be seeking to stop: the cynical, greedy approach of people who wouldn't get their treatment free at home, but calculate they can get everything they want here for nothing. And just a few brief questions can often sort this chaff from the wheat of genuinely "deserving cases". The point is that although the NHS has deep pockets (it costs something like £120 billion annually)- those pockets represent a finite, not an infinite resource, and hence the people who work in it should be careful to husband its funds humanely, but carefully.