Home Office use of patient data: our first duty is to our patients and to do no harm

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Dr Jackie Applebee, Chair of Tower Hamlets LMC, outlines her concerns about NHS Digital data sharing MOU with the Home Office and its implications for the doctor / patient relationship.

At LMC conferences we have repeatedly supported motions that GPs are not agents of the UK Border Agency, we are doctors not border guards and our duty is to our patients.

In spite of this, from October last year there has been a supplementary question added to the GMS1  form for patients to self-declare if they are not ordinarily resident in the UK. The information given will be used to identify the patient’s chargeable status and will be shared with NHS Digital.

There is a memorandum of understanding (MOU) between the Home Office and NHS Digital which allows patient details from General Practice databases to be shared between them without our or the patient’s consent. This information has already been used to deport people and a GP colleague has even been asked to deliver a deportation notice to a patient. The GP refused but this is a clear sign of the governments intended direction of travel.

The BMA, RCGP and the Parliamentary Health and Social Care Select Committee oppose the MOU but NHS Digital have refused to stop sharing data. Sarah Wollaston MP, Chair of the HSC Select Committee has been particularly vocal about this. Government argue that the supplementary questions are necessary because of the cost of health tourism, however, even if all the costs were recouped the evidence shows that the NHS would lose more money than it saves.

Research from Kings College London’s Centre for Global Healthshows a third of vulnerable migrants requiring medical treatment had been deterred from seeking timely healthcare because of concerns that their information would be shared with the Home Office. This results in the to presenting as emergencies at A&E when their illnesses are much more advanced and far more expensive to treat.

There are costs to public health if migrants fear seeking treatment for infectious diseases and their children do not take part in the national vaccination programme, affecting herd immunity.

The government like to blame migrants for many of the ills in society to deflect the blame from themselves and from the policies that they have implemented. The truth is that migrants are a net benefit to the economy and the NHS would collapse without migrant health workers, in addition to the health and humanitarian arguments there are other factors to consider.

In most practices our hard-pressed reception staff are already expected to present barriers to anyone who wishes to register, because they are instructed to ask for proof of address and photo identification. This is not contractual and is simply General Practice’s way of trying to stem some of the inexorable tide of workload by enforcing practice boundaries. In a properly funded NHS with an adequate General Practice workforce we would not feel the need to do this and would take patients at their word when they filled in their address details. Indeed it is possible for people who either do not want to give their address, or who have no fixed abode to use the practice address. Doctors of the World produced a toolkit during their “Stop Sharing” campaign last year explaining to practices how this would work.

GP receptionists do not have time for the additional administrative tasks accompanying the supplementary questions or to explain the form to everyone who registers. With the best will in the world it is bound to lead to racial profiling.

The supplementary questions are ultimately about assessing a person’s immigration status for the purposes of charging them for secondary care (and possibly, in the future, primary care) and more sinisterly, to possibly deport them, often back to war torn countries where they may be tortured or killed.

Finally, make no mistake once the structures are in place to charge migrants it is a short step to using them to begin to charge us all.

Last updated : 13 Apr 2018