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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.

CLICK HERE TO VIEW THE GUIDANCE

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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  • 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?
    Regards
    Paul C

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  • If the guidance was the opposite the Pulse comments would be 'we're not paid to be detectives...'

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  • 1:24 succinctly describes the practical problems of this. It is all very laudable until the problems start rolling in. I suspect it is only months before we get a story about a drugs dealer has registered at 100 practices collecting their benzo /tramadol prescriptions. I wonder who will get the blame. My bet is it'll be the poor GP.

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  • its an invitation for health tourism to increase within a system that's already underfunded and overworked, no wonder we have so many migrants heading to our borders. It's unsustainable and as a tax paying national for the last 32 years I worry that when I most need my beloved NHS when I am most vulnerable and in need of health care it will have gone because of these stupid policy decisions.

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  • That's until NHSE decides to list cleanse and cross them all off when they can't be contacted. They will then publicise that GP's have thousands of ghost patients with the clear implication that we are all fraudulent.

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  • Dr Stokoe,
    Read my posting. If no proof of address is required how can an AT or a CCG ever send out an FP69? FP69's require and address to be functional, ergo they can't list clean anymore.
    Regards
    Paul C

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  • I FOIAed the DH a couple of years ago there is NO legalreason why patients have to prove address. So it could be argued that Practices are collecting ID documents unlawfully, some Practices photocopy them, in these days of identity fraud I hope the Surgerys are insured as if could be traced back to the Surgery you could be potentially sued.

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  • Paul C Going back to early 90's I listed cleaned a couple of Surgerys when I worked at what was then EHH. You did not ID then to register with a Surgery. No response they are removed from the list.

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  • Well unless actually living permamntly can register as Temporary residents.

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  • Some people live permanently but have no bills in their name. Also I believe registering as a Temporary Resident limits referrals? If they use one of those Pay As Go type visa cards which you top up or have wages paid into they may not even have a bank account to prove address.

    DO NOT forget there is no legislation which requires patients to provide ID to register with a GP so a patient is well within their rights to refuse. The NHS is free at point of contact to UK citizens so you cannot delay arguing about ID. You COULD get into hot water by insisting on ID as if you register them as a Temporary Resident and they cannot get the referral they need it may impact on their medical care.

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  • Re the previous post - Temporary residents can be referred in the same way as permanent residents.

    What other contractors would agree to a contract which specified conditions (in this case the ability to restrict new patients to a defined catchment area) but be contractually prevented from verifying those conditions?

    This is yet another illogical edict from a toxic organisation.

    Ditch the contract.

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  • Perfect opportunity for drug addicts to obtain their scripts from multiple GPs!

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  • There is some research on fraud re drug addicts etc I do not have the figures to hand but it is something like 0.3%. That is the figure I have at the back of mind. Anyone old enough, like me, to remember the letters from the FPC warning of people abusing the system with a description. We had them on the wall in staff area of reception at the central London Practice I use to manage. System seemed to work then

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  • Well so many practices must be closing their lists, that the powers that be must be very worried that this does not look good to the general public.
    So they have thought up this wonderful way of effectively ending practice boundaries.

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  • Umm so we can refuse to register people who live outside our catchment area, but we do not have to see any proof of where they live??? Does nobody else see this as sheer stupid?

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  • We were told 25 years ago that all homeless could be registered at the surgery address. This is very very usefull.
    You only have to visit them at thier registered address
    You invite them to monitoring and smears they dint come to - by writing to thier registered address and so save a stamp.

    It works like a dream.
    Most have a mobile phone number you can get them on if you really want them - or a mate who will get them to come in.

    Go with it, it is much much simpler!.

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  • sounds ok to me!, what if I, as an amazingly popular gp, simply register all 2000 of my imaginary friends, (all living on "the good ship venus" or "the marie celeste" or similar). kerching!,
    exception report all the qof (they didn't respond to their letters)
    and while they were at it they kept booking up all the extended hours appointments but kept on DNA'ing....shame.
    of course i know its fraud but who is ever going to find out??

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  • Grab your lifejackets and head for the exit ..... the NHS is sinking faster than the Titanic.Unlimited demand shrinking resources , get some nuts and offer mass resignation , plenty of locum work available.

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  • Nope we won't do this, we are responsible for our registered list so without an address and contact details we cannot safely provide care so we won't. We would certainly defend this if challenged. What a lot of rubbish NHSE come out with!

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  • @7.02 then I hope a patient challenges you. I have just got caught up in the TalkTalk issues and have had a fraud on my current account. I will not be handing over my ID details to the NHS any time soon!

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  • Those of us who escaped the NHS and are working abroad will be having a laugh at this.
    I get paid for the work I do, as do the blood labs, Xray businesses,ambulances, hospitals. All patients know and just accept that if you don't produce your medical card, you produce your credit card and try to claim back if you can.
    No one argues, even the homeless will have a card via benefits. I carry mine at all times, it's now combined with my driving license which I also have to carry.
    The NHS cannot treat the world, because of the attitude of the non docs and cardigans above, it will fail, then those who are vulnerable will be in the same position as the USA.
    Fraud is eliminated as if we can instantly check eligibility, no fancy gadgets needed, just our normal EMR. We occasionally have issues with patients registered for care in another province as we just have to bill and wait to see if we are paid, but if we aren't and the patient refuses to settle up, we refuse to see again
    I have a closed list , as do most GPs, and only occasionally take a new patient via a trusted source, usually another of my patients. There are no boundaries as home visits are very rare, and I have patients as far as 4000 Km's away!! Well one but plenty in the 100-200 km range.
    I have absolutely no issues with any of this, and I know it's supported by the population generally. When I tell them about issues like this in the UK they are shocked and disgusted. I do not see myself as a border guard and never have, I'm just doing my job and protecting the interests of my fellow citizens.
    Eligibility cards are the way forward, the law abiding will have no issues as usual, it's those who seek to commit fraud who will scream and protest.

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  • We have never asked for Id
    The requirement for these documents excludes marginalised people from gp care and many then struggle to get care they are entitled to . We are not overwhelmed but have a greater share of marginalised as we do what the government guidance says as other local surgeries often exclude

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  • Just which moron at the DOH/NHS England is responsible for issuing this 'Guidance'?

    Pulse - Please work tirelessly to unmask the person responsible for the most ill conceived policy since the German Chancellor's 'Open door invite', resonating as loud with all people needing healthcare are welcome policy.

    What qualifications or right do they have to make stuff up and send it out as enforceable or contractual changes without any negotiation or discussion with the representatives of Primary care.

    It will be highly cost effective to get a cheap flight to the UK and pop in to the GP and get all those expensive medications they 'Forgot' to bring with them for their trip. Blowing NHS prescribing budgets.

    Once registered with a GP with their 'fake' and unchecked address, how will any hospital know they are not entitled to outpatient or hospital care.

    Have a serious health problem - need expensive cancer treatment - fly into the UK and get your care for free will soon be around the internet and Facebook!

    The number of drug seekers in the area who will flood the system with prescription requests at all surgeries in an area, as well as an 'Open door invite' as loud as the German Chancellor's all welcome policy.

    Many people use a GP registration as proof of address to then open bank account and credit lines for fraud.

    Once registered if address is wrong imagine that blood result coming in on a Friday night with an Hb of 5 and an uncontactable patient, just who is responsible? The GP or the moron in NHS England who issued this decree.

    Unilateral contract changes or 'Clarifications' are only possible if all comply, and we all refuse, or request a £75 fee for every immediate and necessary patient to stop unfunded work pouring into Primary care, to fund this new service being asked of us, then they will soon rethink this 'Clarification', as the deficits mount.

    Lastly as mentioned by others - Ghost cleansing becomes impossible, as there is no way to prove the patient registered is not real, and if any changes are made by NHS England, the BMA must request them to prove the patient being de-registered is actually no longer in the area under my care before removal, and has another GP who has taken over responsibility for them.

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  • Breaking news...Methamphetamine confirmed to have replaced morning tea at NHSE

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  • Would love to know how we're supposed to identify those registering multiply to enable prescription fraud without ID?

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  • Letter sent to LMC last week:

    It goes without saying that we would always see patients on an ‘Emergency’, ‘Immediately Necessary’, Public Health or Safeguarding basis should the patient’s condition warrant this and provided we have suitable appointments available. We have robust and suitably flexible procedures in place for our Homeless population and openly register patients arriving from the EEA and elsewhere (currently) when their visa indicates they are living in our area for 6 months or longer. We register patients temporarily, depending on length of stay, from the EEA and elsewhere (currently) where there are effective reciprocal health agreements in place (although it should be noted that UK citizens do not have access to an equitable service when we travel and we are advised to obtain Travel insurance for this purpose). Our current Practice protocol treats ALL patients registering with the Practice equitably requiring proof of ID and address. Flexibility is built in to our current system for any registering patients who are unable to provide some or all of this information.

    All that said our staff and indeed our Patient Participation Group, have very strong objections to providing a routine and an entirely free at the point of access Primary Health Care service to the entire world, who have made no payment in to our National Health Service whatsoever. The potential impact of opening our doors to the entire world and this additional burden on an already overloaded Primary Care service is immense.

    Whilst there is a need for clear guidance on Health Care for overseas visitors for Primary Care Service we do feel very strongly that the latest guidance from the BMA and NHS England has gone too far in the extreme and opens the doors to the world to use and abuse the routine service provided to the citizens of the UK who pre-pay for this through the taxation system.

    We feel very strongly that the current guidance remains vague, that urgent review is needed and clear, definitive, equitable and complete guidance for Primary Care Service is produced in the very near future. Whilst we are in agreement that staff who work in Primary Care are not Border Control, and nor do we wish to take on that role, we feel that as UK citizens we have a duty to ensure that the ‘Public Money’ is not misused. We strongly feel that opening the doors of Primary Care Service to those who are not entitled to use it is a gross misuse of Public Monies and needs addressing by Parliament at the highest level most urgently.

    I would be most grateful for the LMC’s thoughts on this matter.

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  • WE ARE A BUSINESS NOT CHARITY. PAY £200 REGISTRATION FEE FOR SUCH PATIENT TO START WITH AND FEE FOR EACH CONSULTATION AROUND £50 PER CONSULTATION

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  • Any thing else - make sure people have topped up their oyster or nectar cards? Maybe even inform of no TV licence!

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