Immediately Necessary and Urgent Treatment

1. Only clinicians can assess if a patient's needs are urgent or immediately necessary
2. Urgent or immediately necessary care must never be withheld, regardless of ability to pay
3. Maternity treatment is always immediately necessary

With the new charging regulations, two assessments must take place:

• the assessment of eligibility for free NHS care by the Overseas Visitors Manager (or OVM, responsible for identifying people eligible for charging)
• the assessment of urgency of the clinical need by a clinician

Regardless of eligibility, or ability to pay, if a clinician deems a patient's care urgent or immediately necessary it must be given. Charges will still be incurred, but must not delay care being given. Doctors of the World recommends using the Department of Health form, attached, to document this decision clearly.

Immediately necessary and urgent treatment

The definitions for these are below, adapted from the Government's guidance on implementing the overseas visitors' charging regulations. The link to the guidance can be found under 'further information'.

Immediately necessary treatment is that which a patient needs:

• to save their life, or
• to prevent a condition from becoming immediately life-threatening, or
• promptly to prevent permanent serious damage from occurring.

Urgent treatment is that which:

• clinicians do not consider immediately necessary,
• but which nevertheless cannot wait until the person can be reasonably expected to return home
• for undocumented migrants, it can be assumed they cannot reasonably return home within 6 months.

DoH states: 'Clinicians may base their decision on a range of factors, including the pain or disability a particular condition is causing, the risk that delay might mean a more involved or expensive medical intervention being required, or the likelihood of a substantial and potentially life threatening deterioration occurring in the patient’s condition if treatment is delayed until they return to their own country'

Maternity Treatment

Maternity treatment:

• all maternity services, including routine antenatal treatment, must be treated as being immediately necessary, to protect the lives of both mother and unborn baby
• no woman must ever be denied, or have delayed, maternity services due to charging issues.
• she should be informed if charges apply to her treatment but not be discouraged from receiving the remainder of her maternity treatment
• OVMs and clinicians should be especially careful to inform pregnant patients that further maternity care will not be withheld, regardless of their ability to pay.

Further information

• 

  Department of Health Guidance on implementing the overseas visitor charging regulations

  www.gov.uk

• 

  Department of Health and Social Care request for clinical opinion form

  migrant.health

• 

  Department of Health and Social Care Clinician Patient Assessment Form

  migrant.health

Relevant topics

• Antenatal and maternity care
• NHS charging
• Urgent and immediately necessary care
• Access to healthcare
• Entitlements to secondary care