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GPs buried under trusts' workload dump

Many GP practices require ID to register patients, despite guidelines saying opposite

Three-quarters of London GP practices ask patients for proof of identification or address before registering them, despite NHS guidelines that state patients do not need either of these to register, a study has found. 

The research, in the British Journal of General Practice, found that 75% of practices asked for documentation, with most of these 'demanding' documentation be presented before registration. 

However, NHS Standard Operating Principles state that ‘registration and appointments should not be withheld because a patient does not have the necessary proof of residence or personal identification’.

The study also identified difficulties in presenting proof of address as a key reason for 17% of Londoners not being registered with a GP, and acknowledged Citizens Advice research whereby 58% of GP surgeries refused to register patients without specific documentation.

The research was a cross-sectional study of 100 practices from ten London boroughs. 

It shared that sex workers, homeless people, travellers, drug users and recent arrivals to the UK were singled out as at greater risk of exclusion from primary care.

Lead author Nathan Hodson, of Harvard University's TH Chan School of Public Health, focused on how practices may ask patients to present their ID or proof of address, but emphasised the need for a policy in case patients cannot do so. Only 12% of practices shared a plan on their website.

The study suggested practices identify a named receptionist who could be spoken to in situations like these, as well as ensuring their website is updated. 

The research concluded that the Equalities Act 2010 might also be breached. Some practices also said that urgent treatment was document-dependent and misinterpreted regulations on immigration status.

Chair of the RCGP Professor Helen Stokes-Lampard told Pulse: ‘General practice offers a safe and non-judgmental space for all patients, regardless of their circumstances, and GPs have a unique understanding of the specific health needs of homeless people and travellers, as well as being highly trained to provide them with holistic care.

‘We know that GPs are working hard to meet the health needs of vulnerable people in the community, and the last thing we want is for patients to suffer because they have been unable to access healthcare - but this study suggests that there is still confusion or an inadvertent lack of awareness at some surgeries around registration eligibility rules.

‘Everyone should be able to access the care they need, when they need it, and the College and other bodies have produced resources to maximise social inclusion in general practice and make access easier for those who are entitled to it. These include training support for practice teams around the legalities of who is entitled to care and what documentation is necessary, so that vulnerable people don’t fall through the gaps due to technicalities that can be avoided.’

This follows a report issued by Doctors of the World last month, which shared that almost a fifth of 2,189 attempts to register new patients across 990 GP practices in 2018 failed due to patients’ inability to produce paperwork of this type, which may discriminate against society's most vulnerable. 

Elsewhere, earlier this year saw Manchester launch the Homeless Friendly social enterprise, to support homeless individuals who struggle with accessing GP treatment.

 

Readers' comments (5)

  • DrRubbishBin

    whatever the rules are this whole issue confuses me. how can you safely provide anything other than first aid (or immediate necessary care) to someone if you've no idea who they are? seems an open door to fraud and inappropriate prescribing, how is this circle to be squared or does no one care ?

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  • World Health Service? We cannot even cope with our existing properly registered patients.

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  • The problem would disappear if Practices were paid for the extra workload. Expecting Drs to subsidise the NHS is the problem.

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  • Azeem Majeed

    It's illogical that hospitals can ask for proof of ID but not general practices. The rules should be the same for all NHS providers.

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  • the original NHS was set up on the principle of paying in a set sum - ie taxation to receive free health care, it was never set up as a freebie to anyone. By denying practices the right to check if patients are eligible for nhs care or live in the practice area you are increasing the risk of double doctoring, fraudulent abuse and poor continuity of care as well as putting NHS eligible patients, ie taxpayers, lives at risk by redirecting funding to those who are not eligible. We should have no issue with providing emergency health care to those in need but at some point there has to be a boundary of what should and should not be provided. Other countries manage with no problem charging patients who are not eligible whatsoever. we can set up funding for charities to supply health care for those who are permanently resident in the UK but don't contribute who are homeless or are travellers etc, in fact they do a much better job than the NHS in finding and supporting these patients so it should be a resource that would be better utilised in this way. All it takes is for some one to sort out the current mess, make it clear and make it fair to taxpayers. Otherwise the NHS will continue to collapse and fail.

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