The Government recently cracked down on so-called 'health tourists' getting free treatment in NHS hospitals. Now the ban may be extended to family doctor services. Health Correspondent Barry Nelson talks to a GP who works with refugees in the region and would be unhappy about refusing treatment to failed asylum seekers.

PAUL Williams was pleased when one of his regular patients who he hadn't seen for some time walked into his surgery.

It was clear that the woman - a failed asylum seeker from a troubled African country - really needed help. She looked very unwell and had not had access to the medication she needed.

"I asked her why hadn't she come in earlier," says Dr Williams, who runs the Arrival Practice, one of only two specialist GP practices in the North-East set up to deal with the recent influx of refugees. Her reply horrified the committed young doctor.

"She told me that she had heard that failed aslyum seekers had lost the right to health care. She had already been refused by the Home Office, she didn't want to be refused again."

The woman, whose husband was beaten to death by a pro-government gang after he made the mistake of giving food aid to opposition supporters, had fled to Britain and sought asylum. But after going through the long process of being interviewed and assessed by the Home Office, she was told she would have to go back to her homeland.

"Rather than get another refusal, she put up with her symptoms until she got really unwell. I told her that she must come here every time she needs to," says Dr Williams.

Now, with the announcement by the Government of a consultation paper proposing new controls over access to primary care services, there are concerns among doctors who work with refugees that genuinely sick people with no access to funds will simply avoid treatment.

The Government points to the five million people who registered with a GP last year, a figure which suggests that some people may be getting treatment to which they are not entitled.

Dr Williams accepts that foreign nationals who come to the UK purely to take advantage of our health system should not be allowed to exploit a service paid for by British tax-payers. But he is concerned that by refusing care for failed aslyum-seekers - who have no legal right to stay in the UK after the often lengthy asylum application process is finally exhausted - he would be going against his ethics as a doctor.

"Britain has no international obligations towards failed asylum seekers but that doesn't mean that we shouldn't offer them treatment," he says.

"Doctors feel very ethically uncomfortable about these measures. If you look at the General Medical Council website, which gives the duties of doctors, the very first line is to make the care of your patient your first concern."

Dr Williams admits he would find it "enormously difficult" from an ethical point of view to deny health care to someone who clearly needed it. "Refused asylum-seekers are some of the most vulnerable people in society," he says. "They not only lose housing and rights to any benefits they have the threat hanging over them of being taken back to the place from which they fled. Often, they are people who also have a real health need."

Apart from the ethical dimension, Dr Williams says there is no evidence that so-called health tourism is happening in the North-East. Out of the 600 people registered with his Stockton practice - a similar number are registered with another Government-funded refugee practice in Middlesbrough - he can only recall one case that might be termed health tourism.

"There is probably one family I can think of who might fit that category. The fact that they could get treatment for their daughter was one of the reasons for coming to the UK. However, there were other reasons for coming and they were certainly fleeing an area of conflict," he adds.

"You could probably call them health tourists but as parents they did the best for their daughter."

Apart from prescribing medication to those who need treatment, Dr Williams says his practice is also very active in promoting healthy living among the refugee community.

"We spend quite a lot of time telling people how to eat healthily, how to avoid sexually transmitted infections and how to improve their mental well-being. This is very much in line with what the Government is encouraging doctors to do, to prevent illness and educate people about healthy living," he says.

Of the 600 patients seen at the Arrival Practice, almost all are from troubled parts of the world where fighting or civil strife is going on.

Dr Williams estimates that about 40 per cent are from Africa, including the Democratic Republic of Congo, Zimbabwe, Uganda, Ethiopia, Eritrea and Sudan. Roughly another 40 per cent are from Iraq, Iran, Afghanistan. The rest are from Burma, Colombia, former Soviet republics and elsewhere.

The medic estimates that around 30 per cent have been imprisoned, raped or tortured. "I have been trained in torture documentation, I hear the most horrific things that human beings can do to one another," says Dr Williams, who belongs to a group called the Medical Foundation for the Victims of Torture.

But being tortured does not automatically make it easier to claim asylum.

"We actually refuse asylum to lots of people who have been tortured. Some can't talk about it all, particularly when women or men have been raped," he adds.

An unwillingness to talk about traumatic experiences sometimes counts against asylum seekers. "There is a big problem of late disclosure," says Dr Williams.

Ironically, many of his patients take some persuasion to visit the surgery.

"I have to encourage some of them to come because they assume that they have to pay," says Dr Williams. "Many have no concept of free health care."

The proposals to allow GPs to charge overseas visitors and to require overseas visitors to prove they are entitled to free treatment on the NHS announced by Health Minister John Hutton last week are now out to public consultation until August 13.

A recent study suggested that health tourism costs the NHS up to £200m per annum. Whatever happens, Dr Williams hopes that it will not come to NHS doctors having to turn sick people away.

"I hope it doesn't come to that," he says. "I hope we can find a way of delivering care to these people without having to make these judgements."

* The consultation document can be viewed online at www.dh.gov.uk/consultations

'A failed asylum seeker is not a person... you have no rights'

HANNAH is a 51-year-old failed asylum seeker from Zimbabwe. She fled the country because of the increasing unrest and violence. Despite her fears and her strong suspicion that her husband was murdered because of his anti-Government views - he died of a single puncture mark after what was supposedly an accidental head-on car crash - her application for asylum for turned down. Now reliant on the charity of friends and well-wishers in Stockton, she is fearful of being refused medical care.

"A failed asylum seeker is not a person, you have no rights. You are not allowed food or shelter, these have been taken away. Now they are adding medicine," says Hannah, who needs medication for stress and high blood pressure. "You are already traumatised and uprooted. I sometimes think that the Government would like you to die in your sleep and then you would be less of a problem. I am being treated for high blood pressure, if you stopped my medication I would end up having a stroke."

Hannah says that doctors should not have to "do the dirty work" for politicians. "If things changed, I would go back to Zimbabwe tomorrow. Until then it seems people like me can go and jump in the North Sea for all anyone cares... which is exactly what Mugabe would like."

Hannah's name has been changed to protect her identity.