Seventy-five per cent of London practices ‘demanded’ to see documentation such as proof of address before registering patients, according to researchers.
A study published this week in the British Journal of General Practice (BJGP) found that, according to their websites, three-quarters of 100 practices across 10 boroughs were in breach of the NHS standard operating principles by stating that documentation was necessary to register.
However, 12% of practice websites studied showed they had procedures catering for patients without documentation, allowing them to register and receive treatment, the researchers said.
NHS standard operating procedures for general practice state that while asking for identification is a ‘legitimate’ part of registration policy, practices should ensure that there are procedures for when patients do not have documentation.
For example, if a patient is unable to produce any supportive documentation but says they live within the practice boundary, practices should accept the registration , the standards say.
The patient groups most affected include marginalized communities, people who are homeless, travellers and recent arrivals to the UK.
‘Reasonable exceptions therefore need to be considered and the individual registered with sensitivity to their situation,’ according to the standards.
‘Confusion’ around eligibility rules
Professor Helen Stokes-Lampard, Chair of the Royal College of General Practitioners, said: ‘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.’
Evidence suggested that websites conflated registration with treatment, as they stated that urgent treatment was document-dependent, the study said. Notable misinterpretation of regulations on immigration status was also found.
Entrenched inequalities
Senior lecturer in primary care research at Brighton and Sussex Medical School, and co-author of the research, Dr Elizabeth Ford said: ‘Restricting access to GP services to those with a full set of documentation places a strain on local hospital emergency departments, which costs the NHS more money.
‘It also entrenches inequalities in society, where people who are the most vulnerable and least well off will continue to have the worst health outcomes.’
‘All practices should create a clear policy for patients who do not have photo ID/proof of address, and update their websites accordingly,’ the researchers concluded.
