There are often press stories about issues between Welsh Health Boards and English Health Trusts. On some occasions, English Trusts are allegedly reluctant to treat patients coming to them from over the border in Wales.

It is important to remember that health is devolved to Wales and it is a different structure in Wales. In Wales, there are large Health Boards whereas in England it is a more complex system of various Health Trusts and Clinical Commissioning Groups (CCG).

There is a considerable flow of patients cross border in England and Wales. In 2017/2018, 6,000 Welsh residents were admitted to Hospitals in England and in the same period, Welsh Hospitals treated 11,000 English residents.

In England, patients have the right to choose which Hospital they are referred to by their GP. This also applies to Welsh residents in border areas who are registered with an English GP. This allows patients to choose from any English Hospital offering a suitable treatment.

In Wales, there is not such a system of patient choice. English residents who are registered with a Welsh GP can choose whether to be treated in Wales or to receive the treatment at an English Hospital of their choice.

Free Prescriptions

All patients registered with a Welsh GP are entitled to free prescriptions including English residents with a Welsh GP. However, prescriptions are only dispensed free at Pharmacy’s in Wales. Welsh patients who have an English GP are eligible for free prescriptions within Wales.

Emergency Care

Health Boards in Wales and CCG’s in England are responsible for Accident and Emergency Services and ensuring that they are present for anybody in their geographic area regardless of that person’s residency or GP location.

Primary Care

There is no funding flow across border between England and Wales. This is in respect of GP Services, Dentistry and Ophthalmic Services. The NHS picks up the cost of primary care costs for some patients who live in Wales on a “knock for knock” basis and vice versa.

Secondary Care

Where English residents with an English GP received Secondary Care Services in Wales, payment for their treatment is agreed locally between the Welsh provider and English Commissioner. For Welsh patients (with a Welsh GP) receiving treatment in England, Welsh Commissioners (usually Local Health Boards) pay English providers.

Conclusion

There is no visible sign of a border between Wales and England (aside from a few ‘Welcome to…’ signs). However, in terms of health there is a very real border. The two distinct health services normally co-exist but at times of pressure and strain the fault lines are exposed.

by Michael Imperato