Information A trip to A and E under Brexit

[Rome Addict]

In the past when I have been in England and needed medical care it wasn't a big deal. I would go to any one of the hundreds of clinics, indicate that I was an American but a) had insurance and b) was perfectly willing to pay cash that day. I never had any problems, I would be seen, they would ask for reimbursement before I left and I would pay. Either I was stupid lucky in picking clinics or since then the rules have changed.

As a result I didn't do the "get the list of doctors who speak english and treat Americans" download from the embassy website. This by the way is something that everybody should do.

I came down with strep throat on day 3 of our time in England. I had put down previous symptoms to allergies as it was monsoon in Thailand. Thursday I self tested with the strep kit you can buy online (thanks Amazon). Yep, streptococcus (sp?). Time to get some help.

I started at a pharmacy. Can you prescribe an antibiotic? I can take, azythromycin, keflex, cipro, tetracycline, etc.. Nope, no longer possible for pharmacists to do so. That was understandable drug resistance is on the rise world wide.

Can you tell me where I can go to see a doctor? They suggested A and E. A and E for the uninitiated is Accidents and Emergencies. A and E translates in American to an American Hospital Emergency room. Any American reading this will understand why I laughed at the idea of going to a hospital ER for a strep throat. I didn't bring my camping supplies. Brit A and E has exactly the same thing. Long waits for non-emergent cases. Hopefully not the 24 hour plus some US hospitals used to have.

I tried again, no I really don't want to go to A and E, it isn't that kind of a thing. Does England have what we in America would call Doc in a Box. Outpatient Clinics? Urgent care? Bingo. The light went on. There is one next town over.

Off to Urgent care. By now it is 6:30 and urgent care is.....associated with a hospital just not a trauma center. The admitting clerk was really sweet and said come back in the morning because you are not going to be seen tonight. We close at 9 and there is a 4 hour wait. Or....(wait for it) you can go to A and E. Rolling eyes symbol here.

The next morning we headed off to a regular medical clinic where our friend takes his kids.
Me: Hello, I"m an american visiting and I would like to see a doctor. I have insurance or am perfectly willing to pay cash today.
Them: Are you a registered patient?
Me: Noooo, how do I do that?
Them: You have to register then you can be seen. The girl that does that isn't here today.
Me: OK. Can you give me the name of a clinic where I could be seen (quickly adding) besides A and E?
Them: There is one about 4 miles away. They gave me the number and address.
And I headed off to another clinic.
Arriving I discover again, I needed to register. This one was a bit more helpful. Registration it turns out is something that is done with the NHS. If I wanted to claim refugee status (tempting, very tempting) I could go through that process and get covered under NHS or (wait for it again) I could go to A and E.
Me: Please understand, I don't need to register with NHS I have every intention of paying the bill the second I am seen. If you don't do see private pay can you give me the name of a private doctor. One that takes paying patients.
Them: Sorry we don't know any.

Giving up I went home to sulk and suffer. Our friend whose house we were sitting arrived from his job 100 miles away.

Me: Hey, Oliver can you call your doctor and see if he will see me tomorrow?
Oliver: sure but if you are that miserable why don't you.........go to A and E. I started to laugh a bit hysterically.
He said "no I'm serious, the equivalent of the Super Bowl is on right now, the only people in A and E are going to be mothers with sick kids or other expats who don't know soccer."

Now for the past 15 years (before heading to Thailand) we ALWAYS bought our car during Super bowl. The salesmen want you gone so they can watch the game. So do their "managers". We would walk in say "look this is what the Kelley Blue Book says this is the wholesale price of the car, we will give you that plus $100. SOLD, now go away. So we headed off to A and E.
A and E: "You can't pay. We will see you, but it isn't possible for you to pay for A and E treatment."
Giving up I succumbed to the pain and said "OK, but I really would like to pay. I'm not a citizen, I don't pay taxes (although that 20% VAT is darn hefty) and I don't feel that it is right that I take advantage of your NHS".
A and E: "you can register as a tourist and the hospital may or may not decide to send your bill to your embassy".
Me: OK (figuring I can work it out with the London embassy later on). The clerk goes off and comes back and says, "Sorry we don't have that form, but don't worry we will see you anyway".
15 minutes later I am seeing a nurse practitioner telling her my tale of woe. She has the perfect response. "Why didn't you call your insurance company? They have a list of providers they work with particularly since your are Blue Cross (BUPA overseas). But all the travel insurance companies have lists of private doctors throughout Europe."

Color me gobsmacked at my stupidity.

Moral of the story: When traveling abroad with trip insurance make sure you get the list of providers they work with. Or check with and print out the list from the US embassy site for the countries you are visiting.

 

[JustTravel]

Thank you for posting this. We spend half the year in Europe and have travel insurance but never asked for a list of doctors from the insurance company. Something to remember to do.

 

[Felicity]

What a time you have had - I am sorry to hear it. Pharmacists can only prescribe within their competence and they have to take full responsibility for prescribing. I am not sure antibiotics fall within their remit, but probably not.

Registering at a NHS GP surgery is pretty straightforward (just a little form filling) and at my surgery, if you are urgent (as you were, in pain with a bad throat) you would be seen the same day although you might have to wait in a queue at the end of the day. Good on you for volunteering to pay. The problem I have found (as I have had a lot of visitors needing help and also quite willing to pay for it) is that the managerial side of the NHS is sorely lacking and they just can't be bothered to go through the process so they treat all comers for free and then wonder why they are running out of resources.

There are lots of private GPs and little or no wait to see them but some of them charge ridiculous rates so a very good idea to get a list of those who are approved by your insurance company, before you leave but a quick phone call to them on the spot and I am sure they would come up with somebody for you. Actually this has nothing to do with Brexit did you mean to write in GB?!

 

[Rome Addict]

No Brexit because the NHS seems to be under attack. I sort of felt that because they are running so short on resources that was part of the reason the regular clinics did not want to see me. In 2013 there was a big stink in the papers about NHS NOT charging overseas and non EU members for services. The doctors got all sanctimonious and said we don't check passports before treating I'll people.

The thing that was so funny about this whole no we don't treat cash customers is every single one of them had a sign in their lobby. The sign clearly stated that if you were not covered by NHS or a member of the E U you would be expected to pay for services. The trick evidently is in receiving said services for which you need to pay.

 

[Pauline]

I agree with Felicity - this has nothing to do with Brexit. This is how the NHS in the UK works.

I have always understood that people not registered with the NHS have to go to A&E where they will be treated at no cost.

When we moved to the UK we registered at our local surgery (doctor's office). We did not have to show ID or any proof that we were legally in the UK. Each time we moved, we registered with the local surgery telling them where our previous one was. Once, when on holiday in Cornwall, I was sick and called the local surgery and got in within an hour. They knew I was registered somewhere else but I did not have to register with them.

The NHS is having problems and these were talked about a lot during the Brexit debates, but the problems currently have nothing to do with Brexit. There is an issue about people who move here and are not EU nationals have to pay for insurance. This did not apply to us because we are Irish citizens and legally permitted to live and work here. When some people apply for citizenship, they find out they need to show proof of paying for health insurance while they lived here. This is kind of confusing.

 

[Pauline]

Registering at a NHS GP surgery is pretty straightforward (just a little form filling)

When we registered they were more concerned about the survey being filled out - to tell them if we smoked, drank, got exercise! The registration part was name, address and age.

 

[Felicity]

Overseas visitors are temporarily registered at GP surgeries if they are staying with me and become ill. In theory they should be asked to pay (or show proof of EU residency) but they rarely are and when they are it is a very small amount. Like Pauline, I have understood that treatment in an emergency at A and E is free although if you then take up a bed, then again, that should be billed, and they are getting better about doing this now but have been very lax.

 

[Rome Addict]

My problem was that I quite simply could not register. Even had I registered they would not have treated me because the office had no procedures in place for private pay patients. The closest private pay doctor is 23 miles away.

A and E is pretty much the same world wide. You are seen and stabilized at a minimum in an emergency. Thailand to Tennessee this is SOP. Then they may perform a wallet-ectomy to determine how much further treatment is provided.

What Brexit discussions have done is make providers aware in a NON emergency situation that they should require payment when using NHS resources. Particularly when treating non NHS eligible patients. This is something that providers now no longer seem to want to do. Whether it is lack of staff to deal with billing, lack of knowledge of fees or fear of NHS retaliation for misuse of resources I cannot say.

The very existence of the posters in offices warning that if you do not qualify for NHS you must pay is an indication of a major shift in how medicine is practiced. 4 years ago nobody asked. It did not matter even in non-emergency instances. I paid out of my personal sense of Justice. It used to piss me off seeing the US system abused so I wasn't going to abuse another country's taxpayers.

Is it all Brexit? Who knows? But suddenly health care in England is about dollars and cents. And it wasn't prior to the campaign.

 

[veronicafrance]

I have always understood that people not registered with the NHS have to go to A&E where they will be treated at no cost.

When we were in the UK recently, my husband needed minor medical treatment. On the advice of a pharmacist we went to a walk-in clinic in Nottingham which was incredibly efficient; he was logged by the receptionist and seen by a doctor within 20 minutes or so. That said, it was probably made easier because although we aren't resident, he's a British citizen and, to our surprise, existed in their database. Not sure how it would have worked for non-EU citizens, but I'm sure they wouldn't be turned away. These drop-in clinics are a welcome way to stop clogging up A&E with people who have stubbed their toes.

 

[PatrickLondon]

My problem was that I quite simply could not register. Even had I registered they would not have treated me because the office had no procedures in place for private pay patients.

What Brexit discussions have done is make providers aware in a NON emergency situation that they should require payment when using NHS resources. Particularly when treating non NHS eligible patients. This is something that providers now no longer seem to want to do. Whether it is lack of staff to deal with billing, lack of knowledge of fees or fear of NHS retaliation for misuse of resources I cannot say.

The very existence of the posters in offices warning that if you do not qualify for NHS you must pay is an indication of a major shift in how medicine is practiced. 4 years ago nobody asked. It did not matter even in non-emergency instances. I paid out of my personal sense of Justice. It used to piss me off seeing the US system abused so I wasn't going to abuse another country's taxpayers.

Is it all Brexit? Who knows? But suddenly health care in England is about dollars and cents. And it wasn't prior to the campaign.

No, this is an older issue which has been around for years - where you draw the line around who's covered by the NHS and who isn't, which has grown more and more complicated as there are so many different potential categorie sof people from overseas who might be considered entitled. Yes, the same feelings that led to the Brexit vote are in play here, but at I think a relatively low level of salience. What's put pressure on the local services is simply the way in which, in their view, government funding isn't keeping up with increased demand, whatever's going on in wider political debate. Government has tightened up regulations on eligibility (doing things like expecting students to pay an upfront fee for NHS access as part of their student visa - who knows, they might introduce one for tourists?!) and nagged local services about doing more to reclaim costs from those they need to, but you're right, outside the hospitals they're not geared up to, and I suspect in their view don't have the spare cash to invest in doing so. GP surgeries are independent contractors, so that's a decision they're free to make, but they can't formally register you since that's the basis of their government funding: so the easier way out for them is to shed the potential complications direct to the emergency end of the system. Walk-in and urgent care centres are not that widespread, and often based in or near hospital A&E anyway.

 

[Dave123]

A 'Useful to know about' thread ...

* NHS Drop-in/Walk-in clinics - I would have suggested this possibility for non-UK residents

* Register with local GP - last time I looked, ours was closed to new registrations

* "20% VAT is darn hefty" - enjoy it whilst it remains so low ;-) Stock-up on children's clothes (VAT-free for under-14s) - my wife is small enough to wear kids' T-shirts, casual tops, etc.

 

[Colo]

Topic close to heart at the moment. Sitting in a Duke University hospital ER for 24 hours with my mother. The first 10 hours were in a hallway. A bed may be available in another couple hours.

Rome Addict you mentioned 24 hour waits - they are alive and well in Durham.

 

[Rome Addict]

A 'Useful to know about' thread ...

* NHS Drop-in/Walk-in clinics - I would have suggested this possibility for non-UK residents

* Register with local GP - last time I looked, ours was closed to new registrations

* "20% VAT is darn hefty" - enjoy it whilst it remains so low ;-) Stock-up on children's clothes (VAT-free for under-14s) - my wife is small enough to wear kids' T-shirts, casual tops, etc.

Quite frankly 20% is insane when combined with your income tax, property tax, TV tax, and all the other miscellaneous taxes. 7 to 10% is pretty normal in the US. If we went to single payor the Congressional Budget Office predicted an average income tax increase of about 4%.

 

[Rome Addict]

Colo - sorry to hear that your mom is that ill. But don't kid yourself it ain't any better in the US and in public hospitals it is much worse. Maricopa County ER averages 15 to 25 hours for non-emergent cases. Even when the patient is admitted it is pretty normal for a 12 to 16 hour wait for a bed. In the meantime the patient is in the hallway. I had a friend whose father bled out and died waiting for a bed on the floor in a hospital in Mesa.
There is a term for it in the US - Code Red. Which means that the hospital has so many emergent cases it exceeds their ability to care for them. Not enough Doctors, nurses, beds, etc.. They had to pass a law in AZ that if you wanted to open or operate a hospital and the county hospital went into code red (something that happened at least twice a week) that county would wave off future ambulance drop offs to a secondary hospital. The secondary hospital must treat the patient regardless of their ability to pay.
The only exceptions were Neonatal intensive care (NICU) and burn victims as the county hospital at the time was the only hospital in the northern half of the state with either a NICU or a burn unit. We would get premie babies from San Diego via air ambulance because NICUs were so rare.

 

[Colo]

Not fooling myself at all.
There is no doubt today or in the last 30 years that the US health system is and has been broke. There is no correction in site and neither political party can... has... or will ever solve the underlying issues.

This being a travel board I will leave it there.

 

[Cameron]

Topic close to heart at the moment. Sitting in a Duke University hospital ER for 24 hours with my mother. The first 10 hours were in a hallway. A bed may be available in another couple hours.

I just stumbled upon this and am sorry to hear this news. I live in Durham, within walking distance of Duke Medical.

 

[Colo]

Thx Cameron.
Sister and mom live in Durham.