Hospitals in England that routinely provide treatment for patients resident in Wales have contracts, or service level agreements, with the Local Health Boards (LHBs) responsible for the care of these patients, which provide for the costs of treatment to be recovered. Other hospitals which treat Welsh patients less frequently will invoice the responsible LHB directly for the costs of individual cases. NHS England has published guidance to confirm which body is the responsible commissioner for all types of patients, including those whose use services across national borders within the United Kingdom.
A comparatively small number of Welsh residents (approximately 15,000) are registered with a general practitioner (GP) in England. A protocol is currently in place between the NHS in England and the Welsh Government which provides for the care of these patients to be commissioned by the clinical commissioning group responsible for the GP practice (a reciprocal arrangement covers English residents who have a GP in Wales). This protocol is currently under review.