Cross-border healthcare

21 November 2014

Article by Philippa Watkins, National Assembly for Wales Research Service

In all areas of healthcare, there is significant cross-border flow of patients between Wales and England. This can largely be attributed to factors of geographic convenience and lack of provision in the patient’s own area. Geographic convenience is an important factor in primary care, where patients living in border areas may choose to register with a GP as close to their home as possible, even though this may not be in their actual country of residence. In October 2014, approximately 15,000 Welsh residents were registered with a GP in England, and around 21,000 English residents were registered with a GP in Wales.

Image from Flickr by Highways Agency. Licensed under the Creative Commons.

Image from Flickr by Highways Agency. Licensed under the Creative Commons.

In secondary and also tertiary (specialist) healthcare, lack of provision in the patient’s locality plays a big part. Some areas may not have the population base necessary to support a large hospital or specialist centre, so patients from these areas might need to travel further – including across the border – for treatment. More than 52,000 Welsh residents were admitted to an NHS hospital in England in 2011-12. In the same period, around 11,000 English patients were admitted to a Welsh NHS hospital.

What does this mean for patients?

For the patients involved there may be uncertainty about their position where there is a policy divergence between the Welsh and English NHS. Frequently asked questions include: are they able to choose the hospital they’ll go to for treatment? Does Wales’ free prescriptions policy apply to them? How long should they be waiting to start treatment?

Patient choice

In England, patients have the right to choose which hospital they’re referred to by their GP. This also applies to Welsh residents who are registered with an English GP. This legal right lets patients choose from any English hospital offering a suitable treatment that meets NHS standards and costs.

The Welsh NHS does not operate a system of patient choice but looks to provide services close to a patient’s home where possible. Patients registered with a GP in Wales do not have a statutory right to choose which hospital they’re referred to. This extends to English residents with a Welsh GP.

Free prescriptions

All patients registered with a Welsh GP are entitled to free prescriptions, including English residents with a GP in Wales. However, prescriptions are only dispensed free of charge at pharmacies in Wales. Patients who have their prescriptions dispensed outside Wales will be charged at the rates that apply in that country.

Welsh patients who have an English GP are also eligible for free prescriptions, but would need to apply to their Health Board for an ‘entitlement card’.

Welsh patients who are treated at hospitals or out of hours services in England, and are charged for prescriptions at the English rate, are able to claim a refund.

Waiting times

Any person (Welsh or English) who is registered with a Welsh GP and referred for tests/treatment will be subject to the relevant NHS Wales waiting times and referral criteria, whether they are sent to a hospital in England or in Wales.

Any patient registered with an English GP will be subject to the English waiting times/criteria if referred to a hospital in England, and the Welsh standards if referred to a hospital in Wales.

Commissioning arrangements

The arrangements for cross-border healthcare commissioning are set out in a protocol between the Welsh Government and the NHS Commissioning Board in England. The protocol aims to ensure that there will be no financial shortfall on the part of any Welsh Health Board or Clinical Commissioning Group in England to provide healthcare services to the other country’s residents.

In March 2014, the Silk Commission on devolution in Wales identified access to treatment for patients in border areas as its principal concern in the area of health. The Commission stated:

We welcome the overarching protocol that has been established by the two Governments on cross-border healthcare. However, we believe that the current arrangements should be strengthened by developing individual protocols between each border Local Health Board in Wales and neighbouring NHS Trusts in England.

We have also heard evidence that there is scope for the Welsh and English health services to work more closely together to develop better joint strategies in relation to, for instance, highly specialist services and maximising joint efficiency savings. This is something clearly in the interest of patients.

In Westminster, the House of Commons Welsh Affairs Committee has announced an inquiry into the cross-border healthcare arrangements between England and Wales, following-up on its 2009 inquiry.