Around 9000 people in Gloucestershire who are registered with Welsh GPs are still are still being treated unlawfully - according to a campaign group. It's a claim disputed by NHS Wales.
Action4OurCare has been fighting for the rights of residents for three years, so they can gain access to treatment they are entitled to at English hospitals.
One of the people caught up in this NHS no-mans land in Guy Rastell - like thousands of others he lives in England, but has no choice but to register with a Welsh GP:
Now he's received a letter from his consultant at Southmead Hospital saying that despite wanting to treat still him she could no longer do so, because "the Welsh NHS are not (and have not previously) funded any of his clinical visits".
I find that astonishing. I've always lived in England since 1947. I find it very strange that after 33 years of continuous attendance, somehow funding comes into it to stop my continuing care.
Guy lives in the village of Tutshill which is in Gloucestershire but also on the border of Wales.
Policies for the NHS in England can vary significantly to those of the NHS in Wales. If you're caught in the middle like Guy your rights to care are complicated:
New rules introduced by NHS Wales
From 2012 Welsh GPs could no longer refer patients to English hospitals without prior permission.
The decision was partially reversed
One year later the Welsh NHS said it intended to allow English patients to use four hospitals in England without getting approval first.
Department of Health ruling
In the same year the Department of Health ruled English patients registered with Welsh GPs did have the same rights to hospital care as all other English residents.
9000 residents are still waiting to be informed of the changes
The new rules have been outlined in a leaflet that was due to go out this month.
Pam Plummer has been campaigning for change since it was recognised the current set up was unlawful.
The issue is that under law you can't change people's health care arrangements without telling them about it. These leaflets need to be issued and we need the approval of the Welsh government for the covering letter to go out with the leaflets so that people can know what's going on. As soon as they're sent out to patients this situation is solved, and we're nearly there. But until those leaflets go out we are stuck. We need the Welsh Government to stop delaying this and get on and allow us to have our lawful rights.
A Welsh Government spokesperson said they not delaying the implementation of the English Department of Health’s changes to referral arrangements for English residents registered with Welsh GPs:
“We are committed to working with NHS England and the Department of Health in England to resolve complex issues before an effective pilot can take place. We want there to be a seamless referral process for patients and Welsh GPs which does not compromise patient safety; reduce the ability of GPs to track patients through the system or put unnecessary additional burdens on GPs. "
The NHS Cross Border Protocol did not expire on 31 March 2016. The legal arrangements for English residents registered with a Welsh GP and vice versa will continue as at present
Guy is one of the patients who is aware of his rights. After ITV News began investigating his case he was told his care would be continued in England.
The Health Board responsible for his care said in a statement:
"It is unfortunate that Mr Rastell received the letter indicating that his treatment had stopped. As soon as this came to our attention we put the necessary arrangements in place to enable Mr Rastell to continue receiving his treatment in Bristol."
We hope that this has not caused too much distress for Mr Rastell and we have spoken to him this morning to offer our support.’
Now Guy wants a resolution for all the other patients who maybe caught up in this cross border confusion.
Gloucestershire Clinical Commissioning Group, who has legal responsibility for medical services for all patients in the county, says it is as frustrated as patients and will ensure that their rights "are put in place as quickly as possible following final agreement between the Department of Health and the Welsh government."