Medical care on overseas assignments: What you need to know
By Tor Johnson, RAF FF Dispersed Families Project Manager
Our research into the experiences of RAF families overseas has highlighted a range of reasons why an accompanied tour in a different country can be an exciting and rewarding experience – travel, living in a different culture and learning a new language, among others. Unlike many typical ‘expats’, an overseas assignment through the RAF allows families to take this step with the additional reassurance that the RAF and MOD are there to support them with any difficulties.
At present it can be difficult for families to understand how this support works until they have already volunteered for an overseas assignment. We have been talking to a range of experts in order to pass information on to you, as either Serving Personnel or family members. In this article we will look at recent changes to medical screening prior to travel, and health-related support for families once overseas.
Why carry out medical screening for dependents
The principle within policy (JSP 770) is that overseas provision for military personnel and families should, where practicable, replicate services provided by the state in the United Kingdom; this therefore includes access to education, welfare services and medical treatment for accompanying family members. However there will be limitations to the range of healthcare services available in some countries, so a screening process must be followed prior to an assignment order being issued by the Career Manager. This is to ensure that a family’s specific needs can be safely met at the intended destination.
Medical screening: how did this use to work?
Until recently RAF dependents were each required to submit a form completed by their own GP, outlining medical needs and conditions. This was then reviewed by the relevant Service Point of Contact (POC) for medical matters. It was identified that this process could cause delays to medical clearance being issued, and that civilian GPs might not have sufficient knowledge of medical provision in the specific overseas location. Families moving from one overseas assignment to another could also face additional difficulties when requesting the required information from a non-English speaking GP.
How does the new process differ?
A new process came into effect from 1st April 2019 with two specialist military organisations taking a lead on medical screening, instead of the individual Services. Families will continue to request screening forms from the Families Section of Movement Support Services (MSS), but will be provided with an updated medical history form to complete themselves, containing detailed questions regarding medical history of each dependent. These should be requested as soon as possible, and at least three months before intended travel wherever possible.
Depending on assignment location, families will be directed to return completed forms to the Central European Practice (CEP) – for European posts under EJSU – or the Global Medical Supportability Cell (GMSC) for other overseas locations. Both the GMSC and CEP are staffed by military medical specialists, with representatives from all three Services, who are able to draw upon more detailed knowledge of individual assignment locations. Having reviewed the forms the family may be contacted to clarify responses or check facts, or they could be asked for permission to contact medical specialists involved in their care where more information is required to assess supportability. Once all information has been taken into account a supportability recommendation will be made.
Possible outcomes are:
- Medically supportable
- Medically supportable, but additional self-certification required closer to the time of travel
- Not medically supportable, with reasons for this recommendation
The recommendation is communicated both to the Serving Person and Chain of Command. There is now a right of appeal for families who are not considered to be medically supportable. The GMSC provides a recommendation on supportability, but the single Service are responsible for the final decision.
Families who are considered to be medically supportable will then be directed to seek advice on any vaccinations required prior to travel.
How about healthcare once we’re overseas?
Families posted to larger units, such as RAF Akrotiri, will have access to medical and dental care at the station Medical Centre, but the healthcare available to your family will vary significantly by location on other overseas postings. Healthcare provision could be through host nation GPs, dentists and hospitals (state-run or private), military medical facilities, or sometimes a mixture of these! Specific information about the medical plan for your assignment can be obtained from your Career Manager.
What can we do if we have questions or concerns?
The GMSC offer a clinical reach-back service – providing clinical advice and support on healthcare queries for entitled RAF personnel and their families overseas. Reach-back queries should be directed to the Clinical Group mailbox which is reviewed by qualified Defence Medical Service (DMS) medical personnel; [email protected] mod.gov.uk. The service is provided during UK office hours only and does not replace in-country emergency or urgent support, should it be required. Defence personnel overseas will continue to use DMS facilities in the firm base or FCO Healthline (Healix) as applicable.
We’re going back to the UK for a few weeks – can we still use UK health services?
Whilst in the UK you may need to seek medical attention, or might want to make sure that you stay up to date with vaccinations or medical screening not offered at your assignment location. GMSC can clarify the processes to be followed to access healthcare facilities back in the UK, both for outpatient and inpatient treatment. This may include access to a Defence Primary Healthcare (DPHC) Family Practice at a location of your convenience. In an emergency you can continue to access NHS hospitals, but ideally should inform the GMSC afterwards to ensure that you have access to follow-up care.
Coming soon: the Global Virtual Practice (GVP)
In addition to the Central European Practice (CEP), the GMSC are in the process of developing a GVP, which you will have the option to register with. The GVP will allow your medical record to be kept up to date with any medical interaction whilst overseas, facilitate face-to-face healthcare delivery at a DPHC practice if required, and facilitate access to UK NHS health screening. It is also intended that your medical pre-screening forms will be recorded with the GVP so that medical personnel can direct you to the most appropriate medical care. Further details will be published later in the year.
Contributed to by Maj L R Gaal QARANC OC Global Virtual Practice, Defence Primary Health Care (Overseas)
Thinking of volunteering for an overseas assignment? Here are some key points to consider:
- Does anyone in your family have significant health needs? If so then whilst they might be well supported at a well-established location, a smaller unit or isolated detachment may not be able to meet their needs. This should not deter you, but you may wish to seek additional advice when considering volunteering for Service overseas.
- It is essential that you are open and honest about medical conditions, both when completing your screening forms and talking to staff from GMSC. Family members arriving overseas with medical needs that cannot be supported are likely to be returned to the UK.
- Make sure that you understand how you can access healthcare whilst overseas. Read and understand the information provided and ask questions if you aren’t sure about anything; it is good to know which doctors, dentists and hospitals you can use before you really need them. You should also try to familiarise yourself with any systems for paying and claiming back medical fees, if applicable.
- Do you need travel insurance? Your family are covered for medical treatment whilst at your assignment location, but if you intend to take holidays or travel then you will need to make sure that you have appropriate insurance in place. Non-military visitors who come to stay with you will not be covered under the MOD provision and should also take out adequate insurance before travelling.
- If anything changes then dependents may be asked to go through the screening process again. For example upon posting from one overseas location to another, following the birth of a child, or as result of a significant illness.
- If your family’s needs do change then it the responsibility of the Serving Person to inform the GMSC. This will ensure that any changes in treatment or management of these needs can be considered.
“It took a bit of time to complete a form for each member of the family, but from there the process was very easy. The day after we sent the forms back I received a call from a nurse at the GMSC, just to clarify a couple of things, and our clearance came through shortly afterwards. It was really reassuring to know that my family’s health needs had been properly considered before our move abroad.” RAF spouse
This news story is included in the Autumn edition of Envoy magazine – the free magazine for RAF personnel and your families too. You can sign up online to have your own copy sent to your home (quarterly).