The European Union Directive on cross-border health care will provide NHS trusts with opportunities to help diversify their income by marketing themselves to foreign patients, says the NHS Confederation.

The Directive, which was adopted in March 2011 and comes into force in the UK in 2013, clarifies the rights of citizens of EU member states to receive health care outside their home countries. It will take effect at a time when the government is proposing to extend choice and diversify providers in the English health care market, and also when Primary Care Trusts (PCTs), which currently retain the power to make decisions on cross-border health care, will be winding down and the NHS will be in the middle of a £15-£20 billion efficiency challenge, says the report, which is published by the Confederation's European Office.

A rise in waiting times for certain treatments in England could lead to an increased number of NHS patients seeking health care abroad and, if this is the case, commissioners will need to have a clear, transparent list of which types of health care they do not fund, says the report. This will be especially important given that the NHS is moving towards a system which will allow for greater variation at local level about what treatments patients are entitled to receive, it adds.

Turning to the Directive’s implications for providers, the report suggests that NHS trusts may be interested in exploring opportunities to provide health services to European patients, in order to diversify their income, and envisages that particular opportunities could emerge for those trusts which provide highly-specialised care and have an international reputation.

Moreover, the government is proposing to remove the private patient income cap which currently reduces the ability of some foundation trusts to treat more non-NHS patients, and this would allow them to "take full advantage of the opportunities emerging from the EU rules," the report adds.

However, it cautions that EU patients must not be automatically classed as private patients; this would be discriminatory and contrary to EU law, and providers would instead have to offer these patients the option of being classed as "paying" NHS patients or private patients, with only the latter being subject to private fees.

The report also sees opportunities for NHS trusts with specialist expertise, particularly in the diagnosis and treatment of rare diseases, emerging from the setting-up of European reference networks (ERNs).  While the Directive does not include information on the format and operation of ERNs, they will concentrate knowledge in medical domains where expertise is rare and foster progress in the diagnosis and treatment of rare conditions, says the Confederation. Therefore, "we could expect positive repercussions for participating trusts in terms of international reputation, learning through collaboration with European colleagues and improved patient care," the report suggests.

- The European Commission's definition of ERNs for rare diseases states that they should "serve as research knowledge centres, updating and contributing to the latest scientific findings, treating patients from other member states and ensuring the availability of subsequent treatment facilities where necessary."