Claim that 500,000 people who haven’t paid any UK tax sign up with GPs per year is wrong

9th Jan 2020


Every year for the past 10 years, 500,000 people who weren’t born in the UK and haven’t paid taxes signed up with a UK GP.


About 650,000 people a year, of whom most are probably immigrants, sign up with GPs in England and Wales. They have all almost certainly contributed to public services like the NHS by paying taxes though.

Several Facebook pages have shared the following claim:

“Every year for the past 10 years 500,000 people who were not born in the UK and haven't paid any UK tax have signed up with a GP in the UK.

“That's an extra 5 million patients that have not put a penny into the pot. That's an extra 5 million patients that were not budgeted for.”

It’s difficult to know exactly how many people born abroad register with a GP, but the latest figures show there are probably around 650,000 sign-ups a year in England and Wales (although this estimate has limitations).

There’s no evidence that these people pay no taxes. Many will be employed and pay income tax and National Insurance, and they will almost certainly pay things like VAT which ultimately contribute to funding for public services.

Where did the claim come from?

This claim seems to be based on a 2014 Daily Mail article, which reports the findings of a 2011 paper from health think tank the Nuffield Trust.

The paper mainly assessed immigrants’ use of secondary care services, like hospital treatment. But as part of that, the paper looked at the number of new registrations with GPs in England between January 2000 and October 2008.

It found that, in that time there were around 550,000 new registrations at GPs per year by people aged 15 or over, with no other registration history.

Its assumption was that most of these people were immigrants, as most people born in England would have already registered with a GP by the age of 15.

The researchers noted that “not all first registrants will be international immigrants” such as those born in England or Wales who didn’t get an NHS number early in life or were mistakenly given second numbers.

There is more up to date data than this though.

How many immigrants are registering at GPs?

There were 6.5 million GP registrations between 2008 and 2018 in England and Wales, where the person’s previous address was recorded as being outside of the UK and it was the first time they were registering for a GP here. So that’s around 650,000 registrations a year. You can read the article we wrote in 2019 about a similar figure here.

But these records don’t always accurately show whether someone’s previous address was outside the UK.

The records of these GP registrations have something called a “flag 4” attached. That is intended to mean the person signing up to the GP surgery was previously living overseas.

Last year, NHS Digital told us that until March 2016, “it was possible for a patient to be registered in one area as flag 4 then move to another area and be registered again as a flag 4”, so migrants who moved around may have been double counted. It also told us a UK citizen who left the country for three months, then re-registered at a new GP may also be counted as a flag 4.

Immigrants almost certainly contribute towards NHS costs

The post claims that these “extra 5 million patients” have “not put a penny into the pot”.

This is not correct. There’s no evidence that the people registering for GP services pay no income tax or National Insurance through working in the UK. Like people born in the UK, foreign-born people pay National Insurance and income tax if they are working. Even if they’re not working, they will also pay things like VAT, fuel duty, tobacco duty and other regular taxes which are used to pay for public services like the NHS.