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GPs must register homeless, boat-dwellers and people staying with friends, says NHS England

GP practices will have to register patients who have no evidence of a permanent address within the practice’s boundaries, including people living on a boat and those staying long term with friends but who aren’t receiving bills, NHS England’s new guidelines have established.

NHS England’s new patient registration directions confirm that GP practices have to treat tourists free of charge, as the BMA recently said.

The guidance says that GP practices can refuse a patient who lives outside of their practice boundary, but adds that the patient cannot be made to prove they live within it or prove that they are who they say they are.

It added that establishing an individual’s identity was ’not the role of general practice’. 

NHS England admits there could be ’practical reasons’ why a practice might need to be assured who a patient is or where they live and therefore it can ‘help the process’ if a patient can provide such documentation.

However, if a practice asks one patient, it has to ask all so as to not risk discrimination - and if they will not produce it, they still have to be registered.

NHS England said it was not a change in regulations but the guidance ’clarifies the the rights of patients and the responsibilities of providers’.

It said there was ’evidence of an increasing number of patients finding it difficult to register with some GP practices’ because they cannot prove who they are or where they live.

The guidance makes clear that GP practices can only turn down a patient for registration if ’the commissioner has agreed that they can close their list to new patients’, if they ’live outside the practice boundary’ or ’if they have other reasonable grounds’.

’In practice, this means that the GP practice’s discretion to refuse a patient is limited,’ it admits.

Listed as examples by NHS England as patient who ’do live in the practice area, but are legitimately unable to produce any of the listed documentation’ include:

  • People fleeing domestic violence staying with friends or family
  • People living on a boat, in unstable accommodation or street homeless
  • People staying long term with friends but who aren’t receiving bills
  • People working in exploitative situations whose employer has taken their documents
  • People who have submitted their documents to the Home Office as part of an application
  • People trafficked into the country who had their documents taken on arrival
  • Children born in the UK to parents without documentation.

However, the clarification comes as the Department of Health is preparing to launch a consultation on extending charging for NHS services from overseas patients in general, which could include them being charged for accessing GP services.

Pulse revealed earlier this year that the Government plans to ask GPs to request to see EHIC cards for all patients in areas with a high population of visitors from the EU.

These pilots would test the feasibility of practices routinely asking patients for documents to enable the NHS to recover the costs of primary care from their home countries in future, the DH said at the time.


Readers' comments (47)

  • We need proper leaders and it is for sure we will not be getting them without a serious fight. I smell revolution in the air.

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  • This comment has been moderated.

  • For what it is worth, we have always applied this - tending to register people who say they live within our practice area, but unable to prove it.

    People are entitled to healthcare - that is the bottom line. I am glad we are getting away from using GPs as part of the 'defense' against immigration. That is not my role.

    It does mean that as a popular practice we have a LOT of patients who lie about their address to stay on our books. That creates problems with workload etc - but that does not outweigh the vulnerable patient's right to receive healthcare.

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  • Cardigan.

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  • Whilst health needs will be addressed, we will not be following this "guidance" and registering all who present. Would question why GP time and resources are free to anyone who happens to visit England - when this is not recipricated when we visit their countries!
    Practice Manager / Essex

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  • Could you claim benefits without proving your identity or address? Could your child apply to a school without proving they were within the catchment? Am I allowed to refuse to give my address to the Inland Revenue? Should I go on or treat readers' intelligence with a little more respect than the DoH does?
    I couldn't care less about fighting illegal immigration at the reception desk. Of course that should not be our role. But at a time when closing lists is made so difficult, GPs should be able to know who they are registering and whether they are obliged to. Otherwise the better performing practices will become victims of their own success with patients refusing to tell them when they move out of the catchment area. I have personal experience of being unable to contact patients about urgent results for this very reason.
    The discrimination argument is flawed. Take the domestic violence reason for not giving an address. How will anybody manage child protection issues if they don’t know where they live?
    What name should be used to create a patient record? And what name should you put on a prescription? How about drug dependent patients who could simply register at multiple practices? Who would know?
    It is one thing to provide healthcare free at the point of service but surely it is not too much to ask somebody to prove who they are.

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  • the health initiatives that we are judged on, breast screening, bowel screening, cervical cytology, QOF, immunisations, require an address that is real,for call and recall.
    When people lie about their address to register we cannot provide this care.
    The health authorities then state we are an underperforming practice for low uptake of these health care programmes.

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  • Bursting with pride for the responses above :

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  • A few years ago we were known as a 'good' practice for drug addicts because we shared care with the local drugs team. Unfortunately we ended up with loads of people all 'living' at the same address, all on blue scrips.
    I can see the no fixed abode registration casuing a real issue for those 'juast a few benzos doc' type patients who need stability but will dr hop.

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  • This will open the floodgates to overseas visitors seeking treatment at the expense of our existing patients, many of whom are unhappy about appointment waiting times anyway. Of course this costs the government little if patients pitch up as TRs because we're all stuck with an antiquated fixed payment set back in 2003/4. Perhaps we need to publicise to patients that waiting times will increase because we are now legally obliged to treat the rest of the world despite the precarious state the NHS is already in.

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  • RE:Anonymous | Practice Manager20 Nov 2015 11:16am

    Good idea. The Government insists on candour and transparency so should be delighted if you put up some posters! Maybe something on your NHS choices page too!

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  • A few years ago we had a patient who was registered at multiple practices in our locality under different names at each one. He used the system very efficiently to obtain vast quantities of medication

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  • Just another nail in the already very airtight coffin. I am already looking into opening a private surgery. Some charge £1500/pt/year
    1000pts=1.5 million a year. I can easily handle 1000 patients a year no matter how many times they wish to see me. For about a £100 a month I would rather join a private surgery than the joke of an NHS we have today. I like those numbers. Any good practice managers looking for a job?

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  • Does it matter who registers with practice? Lets makes it a policy that we will continue to give appointments as needed in our contract and not see a single extra patient. If waiting time goes up, so be it. lets direct patient to local MP and let him respond that why waiting times are up. If medicine budget goes up . simply answer CCG that patients demand it & we can't do anything about it. If referral rate goes up so be it. not our problem. In simple language we should stop gate-keeping role . Its not our job to save this outdated NHS which does not recognize our value. I am fed up trying to protect this NHS who does not want to protect me.

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  • I can't help feel that this could encourage fraud!

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  • We have been compliant with this for a while now and it makes no sense to refuse to register anyone as the practice gets paid regardless. There is nothing in the contract requiring the reception to be a detective agency.

    Besides, what GP surgery wants to invest into the equipment required to verify ID to the same standard as Border Control?

    Key practical question is whether NHSE is going to stop deducting patients with letters bouncing back through their address verification processes.

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  • Took Early Retirement

    "It added that establishing an individual’s identity was ’not the role of general practice’".

    Great! SO no need to be looking for potential cases of radicalization then! One job off the task list.

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  • Without caps and limits to workload, is it any wonder GPs are burning out. This is unacceptable. It's "free for all" with only limited resources.

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  • No doubt when we have several thousand people "legally" registered and living under pseudonyms, GPs will be blamed and probably charged with aiding terrorists / criminal gangs etc to come in and helped them to create a new identity and "vanish" from the authorities. Even better we're having to personally pay for this huge breach in security and denying our own patients reasonable access to all the remaining skeleton services.

    "hello my name is Mr John Smith and I cannot remember where I live or what I do"
    "please can we register you?"
    "yes, I need all my analgesics and 7 referrals to some real Doctors immediately , it is my right you know and please can you also register my 10 friends who also live where I cannot remember where I live, like me they have no IDs"
    "certainly, what are their names?"
    "Oh, they're also called Mr John Smith"

    Are the people planning this really fit to be allowed out in public?

    This is becoming scary!

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  • A patient does not need to be “ordinarily resident” in the country to be eligible for NHS primary medical care –this only applies to secondary (hospital) care. In effect, therefore, anybody in England may register and consult with a GP without charge.

    Therefore all asylum seekers and refugees, students, people on work visas and those who are homeless, overseas visitors, whether lawfully in the UK or not, are eligible to register with a GP practice even if those visitors are not eligible for secondary care (hospital care) services.

    Patients should be offered the option of registering as a temporary resident if they are resident in the practice area for more than 24 hours but less than 3 months.

    All of the above straight from the document. 89 days of us personally paying for the World's health needs, obviously can't expect the same for hospitals because they don't have bottomless money pits like GPs do….
    Please can someone explain how this is not a joke?

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  • Dear All,
    So what happens to the fp69 PROCESS. With these new criteria how can an AT ever decide a patient is no longer registered?
    Paul C

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