Government aims to cut what it calls 'health tourism', but BMA warns plan may cost more to run that it will raise in charges

Overseas visitors and migrants are to be charged for using NHS accident and emergency services in England under measures announced by the government to deter so-called health tourism.

No one will be turned away from an A&E department in an emergency, but there will be a bill to pay afterwards for patients from overseas. Other changes include extending charging for prescriptions to people from overseas, and requiring them to pay higher charges for services that are subsidised for patients entitled to NHS care, such as optical and dental services.

GP and nurse consultations will remain free, which the government believes will reduce risks to public health such as HIV, TB and sexually transmitted infections.

Details of the scheme, which has been drawn up after a government consultation, are still being worked out. Ministers have said they will publish a full implementation plan in March.

Further changes could include overseas visitors being charged for minor surgery that is carried out by a GP and physiotherapy that has come through a GP referral.

Health minister Lord Howe said: "Having a universal health service free at the point of use rightly makes us the envy of the world, but we must make sure the system is fair to the hardworking British taxpayers who fund it.

"We know that we need to make changes across the NHS to better identify and charge visitors and migrants. Introducing charging at primary care is the first step to achieving this. We are already looking at taking action, and next year we will set out our detailed plans to clamp down on the abuse of our NHS."

A Department of Health report this year estimated that up to £500m a year could be recovered through better charging for use of the NHS by visitors. However, it said estimates were based on "incomplete data, sometimes of varying quality, and a large number of assumptions".

There is already concern among many Tory MPs that the ending of restrictions on migrants from Bulgaria and Romania on 1 January will see an influx of migrants, putting additional strain on the NHS and other public services.

The shadow health minister Lord Hunt said: "Yet again, ministers are putting spin before substance – their own report undermines the attempts to grab more headlines with this re-announcement.

"Labour is in favour of improving the recovery of costs from people with no entitlement to NHS treatment. Rather than more grandstanding, the government needs to deliver practical, thought-through changes to make that happen. Instead this out-of-touch government is left asking doctors and nurses to act as surrogate immigration officials."

At present treatment in hospital A&E departments is free, but any subsequent treatment as a result of admission is chargeable. The changes are aimed at tightening and standardising what is and is not chargeable for primary healthcare.

The rules already state that while maternity or antenatal services should not be withheld, overseas visitors should be charged. Asked during the consultation whether maternity care should be exempt, the overwhelming response from NHS frontline staff was that it should not be free for everyone, the Department of Health said.

Doctors' leaders said the proposed changes could cost more to administer than they would raise for the NHS and may deter people in need of treatment from seeking care.

Dr Mark Porter, chair of the British Medical Association (BMA) council, said: "This could mean the system of administering the new charging system will end up actually costing more to run than it collects in revenue. There remains a real risk that some migrants and short-term visitors who desperately need care could be discouraged from approaching the NHS if they cannot pay the proposed charges.

"There is particular confusion over access entitlements to emergency care services, given that the proposals introduce charging for A&E visits, yet say that no patient will be turned away if they need care."

Dr Chaand Nagpaul, chair of the BMA's GP committee said: "It is encouraging that the government has listened to the public health concerns expressed by the BMA about the impact of charging migrants and short-term visitors for GP appointments. We cannot have a situation where any patient with a serious health need is deterred from visiting a GP, especially if their condition raises a potential public health risk."

He added the proposals could introduce "another layer of time-consuming bureaucracy to general practice at a time when GPs and their staff are struggling to cope with rising workload and patient demand".

Dr Helen Stokes-Lampard, a Birmingham GP and spokesperson for the Royal College of General Practitioners, said: "We are grateful that the government appears to have made some concessions to its original proposals and we are pleased that access to a GP will remain free at the point of need.

"However, we still need reassurances that GPs are not going to be pressed into acting as an arm of the Border Agency and we remain unconvinced that the proposals will work across the NHS."