Boris Johnson’s plans to charge foreign staff who help save British lives £625 a year to use the NHS will worsen its staffing crisis, doctors’ and nurses’ leaders have warned.

They have reacted with dismay over the prime minister’s proposal to increase the so-called health surcharge payable by non-EU staff for the third time in four years and demand it should be scrapped completely.



The Conservative party announced on Sunday it was going to increase the surcharge from £400 to £625 a year for all non-EU migrant workers and extend it to all EU citizens who migrate to the UK after Brexit.

The fee is payable for each member of a family migrating, meaning nurses from popular recruitment spots such as the Philippines and India who come to Britain with a spouse and two children will have to pay the government £2,500 a year for the privilege of working in the NHS.

The leader of Britain’s 400,000 nurses called the move inhumane and medical associations warned it would further deter health professionals from coming to the UK where they were desperately needed to alleviate continual and chronic staff shortages.

The Royal College of Nursing (RCN), British Medical Association (BMA) and Royal College of Physicians have criticised the plans as short-sighted and written to Johnson warning him that the move will prove counterproductive.

In the letter, shared with the Guardian, they tell the prime minister the NHS is already under strain with 100,000 vacancies “covering all professions”. They call for all healthcare staff to be exempted from “the pernicious” charge and say it expected “no less from whichever party forms the next UK government”.

Dr Chaand Nagpaul, the chair of the BMA’s ruling council, accused the Conservatives of confused thinking and lack of judgment over immigration, which the party has sought to use as a vote-winner in the election campaign.

He said: “The Conservative party recently pledged an NHS visa to make it easier for overseas staff to work here but, with this latest policy, they would be doing the exact opposite. This shows a clear lack of judgement that risks exacerbating the current workforce crisis in the NHS.

“The government is wrongly implying that migrants don’t pay tax like everybody else when, under this scheme, they will be paying twice for NHS treatment. If they were serious about improving access to healthcare, they would scrap the surcharge and ensure that the NHS is fully funded and free at the point of use.

“The health surcharge does nothing but penalise doctors who are choosing to come to the UK and work in an understaffed, underfunded and under-resourced NHS; doctors who enable the NHS to provide essential care to patients on a daily basis.”

Health service unions say the charge is an unwarranted and costly burden for nurses, who earn an average of £23,137 a year or junior doctors, whose pay scale ranges from £27,000 to £46,000.

The letter points out that an increase to £625 a year would mean a tripling of the charge since it was introduced by the Tories in 2015 as a crackdown on so-called health tourism.

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“After the government doubled the fee in January [from £200 to £400 a head per year], it adds insult to injury to hear proposals to increase it further still,” Nagpual said.

“While no doctor, irrespective of country of origin, should be paying the charge, it beggars belief that politicians want to extend it to more medics [from the EU27] after Brexit despite the NHS facing the worst workforce crisis it’s ever seen.”

Dame Prof Donna Kinnair, the chief executive and general secretary of the RCN, said the fees were a “pernicious and immoral charge” on people who the NHS relied on heavily.

“Forcing hard-working healthcare staff from overseas and their families to pay a fee for NHS services is already an inhumane policy, particularly given they already pay for the service through their taxes,” she said.

Campaigners for EU rights accused Tory minister Michael Gove of “lying” for political advantage when he declared on Sunday that it was “unfair” that EU citizens had “preferential access to free NHS care … without paying in”.

They point out that EU citizens qualify to use the NHS because they pay tax and if the NHS was a pay-in service, they would be obliged to pay in under EU free movement laws.

Campaigners have denounced it as “double tax” for workers coming into the UK from outside the EU, who also pay for the health service through their national insurance contributions.

Minnie Rahman, the public affairs and campaigns manager at the Joint Council for the Welfare of Immigrants, said: “Raising the NHS surcharge for the second time in two years is nothing more than a way to scapegoat migrants and distract everybody from the fact that it’s austerity that is crippling our NHS.”

Planned spending for 2019-20 is set at just under £140bn but the surcharge raises just £250m a year and would raise an estimated £390m if increased to £625.