Treasury debt and NHS costs – can we close the gap administratively?

The pandemic created a major funding problem of Treasury debt and NHS costs. Pressures on taxpayers and patients will increase – both have limited resources. Can administrative restructuring alter citizens’ behaviour by encouraging taxpayer contributions and discouraging patient wastage?

Cheating the NHS is simple – right of abode and any UK address allows GP registration with Form GMS1. Indicate ordinary residency for secondary treatment or short term for primary. Strict assessment of residency status is not undertaken and patients’ statements thereon are optional. Live overseas, keep registration active, do not pay UK tax but earn free treatment. NHS costs are easily wasted by non-residents.

Those cheating HMRC are harder to find: HMRC statistics indicate that England has about 27 million adult taxpayers but NHS has nearly 39 million adults registered with GPs. Declaring NHS residency (Form GMS1) means that HMRC non-residency declarations to avoid tax is not allowable (Finance Act 2013). Registrations with NHS and HMRC should equate but do not.

NHS Digital in 2018 noted that approximately 6 million (20-60 age group) GP registrations were not accounted for in ONS population statistics of England residents. Scotland NHS and Northern Ireland figures are unclear. The actual UK position is unknown. Something is wrong administratively when residency declarations for NHS free treatment do not match the HMRC residency declarations. This problem needs fixing to cut costs and increase income. Stricter controls should alter behaviour.




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