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Independents' Day

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 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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  • 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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