NHS reforms could mean more patients seeking treatment abroad, warn experts

October 18, 2010

The planned shake-up of the NHS in England could see a rise in the number of patients seeking treatment elsewhere in the European Union, warn experts on bmj.com today.

Researchers at the London School of Hygiene and Tropical Medicine say more people could turn elsewhere if they face long waits for treatment or other forms of rationing as new GP commissioning groups seek to control their budgets.

They argue this is "another challenge for general practice commissioning" and look at the implications for healthcare planning across Europe.

British residents have had the right to obtain treatment in another EU country since 1971, although currently the number is small, write Helena Legido-Quigley and colleagues.

Initially, the opportunities were limited but, since 1998, a series of court rulings have increased patients' rights to treatment in other EU member states, particularly for non-hospital care.

However, there is still a lack of clarity about whether patients can go abroad freely, without seeking authorisation, to use specialist medical equipment or expensive facilities usually located in hospitals.

A recent case ruled it was necessary that European law "did not threaten a system of planning that would ensure an appropriate geographical distribution of such costly equipment."

This ruling is important, say the authors, because it begins to clarify the previously uncertain legal interface between hospital and non-hospital care. They write: "It is not whether complex treatments must or must not be provided in a hospital setting. Rather, it is whether their cost and the importance of avoiding waste from the underuse of facilities demands that their distribution be subject to planning."

This also supports the English Department of Health's advice, issued earlier this year, which highlighted the lack of clarity about use of specialised or cost intensive equipment or infrastructure.

If general practice commissioning groups do come about they may not have to deal with many patients who choose to obtain treatment abroad, but they should be aware that some may exercise their rights to do so, say the authors. Where this involves inpatient care or "major medical equipment" they will need to establish appropriate mechanisms for authorisation. Quite how they will do this remains to be seen, they conclude.
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BMJ

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