This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

GPs go forth

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)

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

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.
    Paul C

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

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

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

  • 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.

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page50 results per page

Have your say