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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)

  • 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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