What you don’t know about… S2 funding

In the latest instalment of our series looking at policies, funding pots and new initiatives that may have slipped your notice, Dr Lucy Douglas investigates the S2 funding route and why GPs may want to recommend it to patients

What is S2 funding?

The Planned Treatment Scheme (S2 funding route) entitles eligible patients to NHS funding for planned healthcare carried out in the state healthcare system of an EU country, or an EEA country ie. Switzerland, Norway, Iceland or Liechtenstein. 

To be eligible for S2 funding:

• The patient must have an authorised application before the treatment
• The planned treatment must fall under the providing country’s state healthcare scheme (not private)
• The treatment must be routinely available to the patient under the NHS in their medical circumstances
• The NHS must confirm that it cannot provide the specified, or equivalent, treatment in a medically acceptable timeframe for the patient’s condition
• There must be medical written support from a clinician/healthcare provider from the providing country for the need for treatment following their full medical assessment
• There must be medical written support from a clinician/healthcare provider from the providing country for the planned treatment dates and estimated costs
• The patient must be a resident in the UK, registered with an NHS GP, and entitled to treatment on the NHS
• The patient must have seen their NHS GP for a consultation/assessment about the condition in question

The scheme is not exclusive to England. Each of the countries within the UK has its own website for the S2 scheme detailing the eligibility criteria, exclusions and how to apply. 

Why don’t I know about S2 funding?

It seems that there is limited awareness about S2 funding.I have asked many colleagues, even those within the Anglo-German and Anglo-French Medical society, both of which I am a member, if they are aware of the scheme and almost none are. Planned healthcare in the EU has been available for UK residents since 1973. It was initially known as the E112 route, and then became the ‘S2 scheme’ under EU regulations that came into force in 2010.

According to NHS England in July 2016, there were only 3.66 million patients on NHS waiting lists of whom 1,076 were waiting more than 52 weeks. This is compared with 7.25 million patients on waiting lists now, with 302,000 waiting more than 52 weeks. It seems likely therefore that while the UK was part of the EU, the need for S2 funding was limited, given NHS waiting times were not excessive. It’s possible that many who were aware of the scheme assumed it had ceased at the point at which the UK left the EU. In fact, this was my own understanding until I came across a discussion on a French property social media group in which the S2 scheme was mentioned as a means of accessing healthcare in France. 

According to NHSE’s figures (obtained by a FOI request) applications for S2 funding have been rising slowly since 2019, but these remain small in relation to the seemingly ever-growing numbers of those on NHS waiting lists. This may reflect limited patient awareness of the scheme, perhaps due to the fact that the government does not seem to promote it.. Also patients without close ties to the participating countries may feel daunted at the prospect of negotiating an unfamiliar health care system with associated travel, language and insurance issues. 

What are the benefits of S2 funding?

Many UK residents will have friends, family or other links within the approved countries making this route to access planned healthcare a potential accessible option. Even in the absence of specific knowledge of the healthcare systems of these countries, patients may still be happy to investigate the S2 route in order to access necessary healthcare funded by the NHS. 

As a likely consequence of current longer waiting times, there is evidence of increased private healthcare expenditure in the UK. The State of Health and Care 2022 report noted that the UK is the ‘G7 nation with the fastest rise in healthcare expenditure from out-of-pocket or voluntary insurance sources.’ According to the Private Healthcare Information Network records, there were 11,000 more privately insured medical admissions in 2023 compared to the same period in 2022.

However, according to the Resolution Foundation, up to 30% of working age adults in the UK have no savings immediately available, so would be unable to fund private healthcare in the UK should the need arise, without incurring significant debt. 

In order to reduce costs, those with limited means may seek private medical care outside the UK. However there have been some high profile cases of harm and even death when patients have sought private medical treatment abroad. 

What should I look out for with S2 funding?

Although S2 funding is a way for patients to get necessary treatment quicker than expected if it were on the NHS, that does not mean that it is a cost-free route for patients. Co-payments may be required in line with local policies. Furthermore, travel, accommodation and translation costs are not covered. Patients need to be made aware of this and weigh up the pros and cons in their minds. 

How does S2 funding fit in with general practice?

General practice is critical for patients seeking S2 funding, as one of the requirements is that the patient must have seen their GP for a consultation or assessment of the condition they want to get funding for – this only applies to treatment in secondary care. Following this, GPs would then need to supply them with copies of relevant clinical correspondence relating to this condition and the need for treatment (eg, referral letters.) There would be a requirement to confirm local waiting lists for this to be deemed excessive, however this information would likely have been communicated directly to the patient, who is now considering S2 funding, from the secondary care provider. 

GPs are not expected to find a provider of medical care in one of the participating counties on behalf of the patient; the patient needs to do this themselves. Exactly how to access a medical specialist will likely vary country to country, and therefore the S2 scheme may be most easily accessed by those with contacts or familiarity with the EU or EEA healthcare system being considered. 

Once the patient has found a provider that will carry out the treatment as state-funded healthcare, they must fill out the relevant sections of the S2 Provider Declaration form for the particular UK country (England, Scotland, Wales and Northern Ireland). This form is then submitted with other documentation, including the UK S2 Application form, as part of the formal request for funding. 

NHSE has confirmed that immediately necessary follow up would need to be included in the S2 application, for example physiotherapy after a knee replacement. However, for any necessary long-term follow up, the patient would require referral back into the NHS system. It is not expected that the patient should encounter barriers when being referred back into the NHS system for follow up in line with standard NHS policies, even if their primary treatment was abroad as part of the S2 scheme.. 

What can I take away from this?

When GPs are faced with patients struggling on long NHS waiting lists for planned care, it might be worth making them aware of the S2 funding option at this point in case this is something they might be motivated to consider, especially if they are already considering self pay private treatment in the UK or abroad. Aside from benefiting patients, advantages to GPs may also include:

• Patients do not require GP support whilst on a long NHS waiting list
• GPs are not expected to work beyond their expertise whilst patients wait for specialist input
• GPs are not required to fill gaps in self funded UK private medical care such as organising blood tests which many GPs report is an increasing problem

Dr Lucy Douglas is a salaried GP in West Yorkshire and a GP with Extended Role (GPwER) in rheumatology and MSK in Lancashire.

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