Doctors play a limited but important role in the system by ensuring that chargeable patients, who are not accessing an exempt service, receive appropriate, necessary and timely treatment.

DHSC's guidance is clear that it is not the role of clinicians to make judgements about the eligibility of patients for NHS care. Non-medical staff – typically overseas visitors managers (OVMs) and their teams – are responsible for identifying, assessing and recouping costs from chargeable patients.

Doctors responsibilities

However, in their clinical assessment of a patient and in their communication of this assessment, doctors play an important role. In addition to their ordinary ethical duties of care, a doctor’s core responsibility is the clinical assessment of chargeable patients to:

• determine whether the treatment that is required is immediately necessary, urgent, or non-urgent; or
• confirm that the condition or suspected illness is one for which treatment is exempt from charge under the regulations; and
• decide whether the patient is stable enough to be discharged and what further monitoring is required.

Urgent treatment

Treatment classified as 'immediately necessary' or 'urgent' cannot be delayed or discouraged, even if a patient cannot pay for it. 'Non-urgent' treatment will be withheld if a patient cannot pay in advance.

Exemptions from charging

Treatment of some conditions is exempt from charges, including treatment of specified communicable diseases and of any condition resulting from a patient’s experience of sexual or domestic violence, female genital mutilation or torture.

Your ultimate responsibility

Doctors' ethical training is based on a duty to respond to need. Doctors in the NHS may not be used to making decisions that may lead to clinically indicated, but otherwise non-urgent, treatment being withheld in lieu of payment.

However, clinicians play a vital role in protecting patients by ensuring that chargeable patients receive appropriate and timely treatment for urgent and immediately necessary health needs, irrespective of their entitlement status or ability to pay.

What secondary care doctors need to know

• The criteria by which overseas patients can access NHS secondary care services without charge are complex.
• Eligibility for free non-primary care is determined by the residency status of a patient. Specific patient groups are exempt from charge, including vulnerable populations.
• Doctors are not expected to make judgements about the immigration or residency status of patients. Non-clinical staff are responsible for both the implementation and administration of the charging system in relevant NHS-funded bodies.
• Doctors have a vital role in assessing whether the treatment a chargeable patient requires is 'non-urgent', 'urgent', or 'immediately necessary' as defined in the Department of Health and Social Care guidance. This is the doctor’s decision alone.

Read more about the role of doctors in charging in primary care.
​