The consultation covers two distinct issues. Firstly it covers better recovery of costs from overseas visitors currently eligible for charging, whether due to an unplanned or a planned healthcare need. This includes recovery of costs for EEA citizens from their respective social security systems. The size of these groups and level of unrecovered costs is unknown as chargeable patients are often not identified when accessing care.
Secondly, the consultation extends both the scope of charging (particularly to primary care and other non-hospital NHS commissioned services and A&E) and the categories of migrants to be expected to make a financial contribution through insurance or health levy (those here on fixed visas). In future this would include overseas nursing students and overseas staff working in the NHS who do not have unlimited right to remain. Figures are not yet available on how much these groups cost the NHS currently.
In order to operate as a comprehensive system the proposals would require a modified system of universal NHS registration for all so that visitors/migrants and their charging status could be tracked throughout the healthcare system. However, the proposals acknowledge that this would need to be done on a pooled basis e.g. by NHS England (or their equivalents in the devolved countries), rather than by requiring individual GP practices to administer the arrangements.