England/Wales Cross Border Frequently Asked Questions

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Other health & care services

Complaints

 


General questions

Why is this happening?

Responsibility for the NHS in Wales is devolved to the Welsh Government. This means that it is separate from the NHS in England. The existing cross-border protocol between England and Wales sets out an agreement for the care of patients living along the border who reside in one country, but are registered with a GP practice in the other country. Due to changes to the law brought about by the NHS Act 2006 (as amended by the Health and Social Care Act 2012), if you live in England and are registered with a GP practice in Wales along the border then the choice of secondary healthcare and services provided in England needs to be offered to you.

What is the referral assessment service (RAS)?

The referral assessment service (RAS) is a referral system to enable English residents (registered with a Welsh GP practice) to access choice of secondary care provider in England.  The RAS acts as a single point of contact for Welsh border GP practices to refer English cross-border patients to England for consultant-led secondary care.  The RAS offers English residents the choice of secondary care in England in line with NHS Constitutional rights or to be referred back to NHS Wales, to be treated under Welsh standards and policies if the patient wishes.

What does this change mean for me, as a patient?

If you live in England and you are registered with a GP surgery based in Wales which is part of the referral scheme and you need to be referred for treatment either in a hospital or clinic, you will be referred to the RAS, which will offer you a choice of healthcare providers in England.  If you live in Wales and are registered with either a Welsh or English GP you will experience no change to your current GP arrangements.

What happens if my GP practice isn’t part of the new scheme?

If you live in England and you are registered with a GP surgery based in Wales that is not part of the new referral scheme then you will default to being treated in Wales to Welsh standards.  However, if you wish to be treated to English standards by an English provider then you will need to speak to your GP or contact your Clinical Commissioning Group to arrange for this to happen. You will not experience any delay in treatment by choosing this option.  However, it is possible that you may have to change your GP.

Will this mean I can’t go to a hospital in Wales?

If you live in England and you are registered with a GP surgery based in Wales and you wish to receive your care in a hospital or clinic in Wales then you can do so and you will receive high quality treatment under Welsh NHS standards and policies. However, you will not then be covered by the NHS Constitution and may lose some of your entitlements that the Constitution guarantees, such as a choice of providers or waiting times standards which apply in England.

What will happen if I need to be seen in hospital or by a specialist?

If you are happy to receive your treatment and care in a hospital or at a clinic in England then your GP will arrange for your details to be sent to the RAS. A member of the RAS will contact you to arrange your appointment at the hospital or clinic of your choice. If you prefer, you can still choose to receive your treatment and care in a hospital or clinic in Wales. If you are cared for in Wales you will receive high quality NHS care to the same standards and policies that apply in the Welsh NHS.

What happens if I have already been referred to a service in Wales, or am currently on a waiting list for treatment?

If you have already been referred for treatment, there is no obligation to change your current treatment options. If you wish to change your existing treatment plans, please contact your GP practice to discuss your options. Please note that changing your choice of provider may not necessarily mean that you are seen within a shorter waiting time.

Can I have treatment in Wales when I have a GP in England?

If you live in England and have a GP in England you will normally receive your treatment from the NHS in England, and your Clinical Commissioning Group is responsible for your care. Generally, you will receive your care from an English hospital.  If you as a patient feel that there is a strong medical reason why your treatment should be provided in Wales, you should approach your GP and the Clinical Commissioning Group, explaining the reasons.

Can the NHS move my treatment from a Welsh hospital to an English hospital without my agreement?

Your doctor would discuss any change to your treatment, but it is highly unlikely that the location of an ongoing course of treatment would be moved. However, a new treatment could be commenced in a different location.

Other health & care services

What if I need to access care other than consultant-led services or hospital based treatments?

These changes only apply to consultant-led care which is usually delivered in a hospital or clinic. All the other services you receive from your GP practice should remain unchanged. This includes, but is not limited to, most screening tests, palliative or hospice care, non-emergency patient transportation, and most mental health services.

If I have a GP in Wales but live in England, what screening services am I entitled to?

NHS England commissions the national screening programmes for England.  The majority of screening programmes are based on residency, so if you live in England, the screening services you receive will normally be those for English residents. Having a Welsh GP does not change this.  However, Diabetic Eye Screening eligibility is based on your GP registration; these would therefore be arranged based on your registration with a GP in Wales.  You will be invited to attend screening appointments by the organisation which carries out the screening. If you have any questions about your entitlement to specific screening programmes, you should speak to your GP in the first instance.

If I have a GP in England but live in Wales, what screening services am I entitled to?

Public Health Wales commissions the national screening programmes for Wales on behalf of the Welsh Government.  The majority of screening programmes in Wales are based on residency, so if you live in Wales, the screening services you receive will normally be those for Welsh residents. Having an English GP does not change this.  However, Diabetic Eye Screening is based on your GP registration; these would therefore be arranged based on your registration with an English GP.  You will be invited to attend screening appointments by the organisation which carries out the screening.  If you have any questions about your entitlement to specific screening programmes, you should speak to your GP in the first instance.

Will I have to pay for prescriptions?

NHS prescriptions are free of charge if you have:

  • a GP who works for NHS Wales, and;
  • your prescription is dispensed by a pharmacy which is employed by NHS Wales.

If you live in England and have a GP in Wales, you are able to get prescriptions free of charge as long as the prescription is dispensed by a pharmacy employed by NHS Wales. If you choose to have your prescription dispensed in England, you will need to qualify for free prescriptions under the English criteria.

If you live in Wales and have a GP in England, you may still be able to get prescriptions free of charge by having an exemption card.  Further information is available on the NHS Wales Help with Health Costs website. You can apply for exemption cards to the following address:

NHS Prescription Card Exemption
NHS Wales Shared Services Partnership

Cwmbran House
Mamhilad Park Estate
Mamhilad
Pontypool
NP4 0YP

If you have a NHS prescription dispensed in England, you will be charged at the rate set by the Department of Health and Social Care in England.

If you have been referred by your Local Health Board to a hospital in England, and are given an English prescription, you will have to pay the current rate set by the Department of Health and Social Care, even if you take it to a Welsh pharmacy. However, provided you are a Welsh resident, you may claim this fee back from the NHS Wales Shared Services Partnership as long as you have proof of payment.

Can I make use of English or Welsh drop-in centres?

Arrangements vary, but you would normally be seen and assessed regardless of where your GP practice is based.

What happens if I need out-of-hours care?

Patients access the out-of-hours services that have been arranged for them by the GP that they are registered with.  If you are registered with a GP in Wales you should access the out-of-hours service provided by your Local Health Board in Wales and your GP practice will be able to provide you with up to date contact details for this. However, if you wish to go to a nearby out-of-hours primary care centre in England, you can ask your own out-of-hours service if an appointment could be made for you.

Who do I call if I need urgent help, is it NHS 111 or NHS Direct in Wales?

If you live in England you will be able to use NHS 111 to get urgent help if you need it. NHS 111 currently only holds information about services in England. If you need information about services in Wales, they can transfer you to NHS Direct Wales, (who currently provide information to people who live in Wales).

If you live in Wales you can contact NHS Direct Wales on 0845 46 47 or 111 (if available in your area).  NHS 111 in Wales is a non-emergency helpline that is being rolled out nationally across Wales over a period of three years from 2018.  NHS 111 in Wales provides a free treatment and advice service helpline managed by a team of professionals and is available via telephone 24 hours a day, seven days a week.

If you have a medical emergency or critical life threatening problem then please call 999 irrespective of where you reside or are registered with a GP.

What happens if I need an ambulance?

This change will not make any difference to emergency ambulance services. You will still get an ambulance no matter where you live if you need one by calling 999.

Who do I contact if I require emergency NHS dental treatment in England?

If you think you need urgent treatment, contact your usual dental practice and ask to be seen as an emergency. If you require out-of-hours emergency NHS dental treatment or do not have a regular dentist, you can still access urgent care by calling NHS 111.

Who do I contact if I require emergency NHS dental treatment in Wales?

If you require in-hours emergency NHS dental treatment you should contact the dental practice where you receive your regular NHS dental care.  If you require out-of-hours emergency NHS dental treatment you should contact your Local Health Board for details of the level and location of the services available.

Local Health Boards also provide emergency care/access sessions for those patients who do not have regular access to NHS dental services.  Further information and helpline details can be found on the NHS Direct Wales website.

Can I get help with transport across the border when I need to cross it for treatment?

This depends on your circumstances as there is no single non-emergency patient transport system. You will need to approach the contact centre that deals with the local authority area where you live.

The rules are that:

  • a patient requesting NHS-funded transport will be assessed for eligibility;
  • eligibility for non-emergency transport is based on medical need;
  • patients in receipt of benefits may be able to reclaim all or some of their travel costs through the applicable hospital travel scheme (Wales / England);
  • patients resident in England, registered with a GP in Wales should contact the appropriate Welsh Ambulance Service contact centre for their GP’s region [see below];
  • patients resident in Wales, registered with a GP in England should contact the Clinical Commissioning Group where their GP is located.

Welsh Ambulance Service Regional Contact Centres:

  • North Wales: 0300 123 2317
  • Powys and Ceredigion: 0845 840 12 34
  • Central and West Region: 0300 123 2303
    Covering Neath Port Talbot, Bridgend, Swansea, Carmarthenshire and Pembrokeshire.
  • South East Region: If booking transport for the first time telephone 0800 32 82 332 (8.30am to 6.00pm on weekdays) or if you would like to book subsequent appointments telephone 0300 100 00 12 (8.00am to 4.30pm on weekdays).

Complaints

If I have a GP in Wales and I wish to make a complaint about the GP, what do I do?

Your first step will normally be to speak to your GP at your GP surgery.  You can speak to them about your concerns or write them a letter or an email.

If you don’t feel comfortable doing that, then you can raise the matter with the relevant health planning body, which will normally be the Local Health Board.

You may also ask the local Community Health Council (CHC) which covers your Local Health Board’s area to help you. It can provide a free and independent advocacy service to help you or the people acting for you to raise a concern.

If you are not happy with the response to your complaint, you can refer the matter to the Public Services Ombudsman for Wales.  More information on the process can be found in the guidance Putting Things Right.

If I have a GP in England and I wish to make a complaint about the GP, what do I do?

Your first step will normally be to speak to your GP at your GP surgery.  You can speak to them about your concerns or write them a letter or an email.

If you don’t feel comfortable doing that, then you can raise the matter with NHS England.

You may also ask the local Healthwatch which covers your GP’s area to help you. It can provide a free and independent advocacy service to help you or the people acting for you to raise a concern.

If you are not happy with the response to your complaint, you can refer the matter to the Parliamentary and Health Service Ombudsman (PHSO).  More information on the process can be found on the NHS website.

If I receive treatment in a Welsh hospital and I wish to make a complaint about it, what do I do?

Your first step will normally be to raise the matter with the member of staff concerned. If you don’t feel comfortable doing that, then you can raise the matter with the relevant health planning body, which will normally be the Local Health Board.

You may also ask the local Community Health Council (CHC) which covers your Local Health Board’s area to help you. It can provide a free and independent advocacy service to help you or the people acting for you to raise a concern.

If you are not happy with the response to your complaint, you can refer the matter to the Public Services Ombudsman for Wales.  More information on the process can be found in the guidance Putting Things Right.

If I receive treatment in an English hospital and I wish to make a complaint about it, what do I do?

Your first step will normally be to raise the matter with the member of staff concerned. If you don’t feel comfortable doing that, then you can raise the matter with the relevant health planning body, which will normally be the Clinical Commissioning Group.

You may also ask the local Healthwatch which covers your GP’s area to help you. It can provide a free and independent advocacy service to help you or the people acting for you to raise a concern.

If you are not happy with the response to your complaint, you can refer the matter to the Parliamentary and Health Service Ombudsman (PHSO).  More information on the process can be found on the NHS website.

Who is responsible for inspecting and monitoring health services in Wales?

Healthcare Inspectorate Wales (HIW) is the independent inspectorate and regulator of all healthcare in Wales.

HIW regulate and inspect, on behalf of Welsh Ministers, NHS services and independent healthcare providers in Wales against a range of standards, policies, guidance and regulations and highlight areas requiring improvement.

For more information regarding the role of HIW, please refer to the HIW website.

Who is responsible for inspecting and monitoring services in England?

The Care Quality Commission (CQC) is the independent regulator of all health and social care services in England.

The CQC does not have the powers to investigate or resolve complaints, but if you have experienced poor care or know that poor care is being provided somewhere you can report it to the CQC, anonymously if you wish.  You can also tell them if you feel you have received good care.