Health

GP surgeries deny care to vulnerable people without ID documents


GPs are wrongly denying care to homeless people, travellers and recent arrivals into the UK by telling them to produce photographic identification or proof of address before they can register or get urgent treatment.

Sex workers and drug users are also being prevented from accessing GP surgeries for the same reason, according to findings published in the British Journal of General Practice.

Three-quarters of 100 London GP surgeries are breaching NHS guidelines by insisting on their websites that people need proof of identity and residence in the area before they can be admitted to their list of patients.

Patients are being wrongly told to comply with such requirements even though they breach guidelines drawn up by the General Medical Council and British Medical Association, as well as NHS England, the researchers found. Some surgeries may also be acting illegally by linking the ability to register with someone’s immigration and ethnicity, in breach of the Equality Act 2010, they said.

“Most practices stated that ID and proof were required, offering no alternative for people without ID, thereby breaching NHS England guidelines. Refusal to accept tenancy agreements and mobile phone bills presents a particular barrier to people who often move address, who are also those most likely to need to register at a new practice frequently,” found the researchers, who were led by Nathan Hodson of the TH Chan School of Public Health at Harvard University.

Many surgery websites wrongly stated that proof of ID and address were needed for them to register new patients, even though NHS standard operating principles are clear that those are not acceptable grounds on which to stop someone registering.

Such barriers could damage patients’ health and increase the NHS’s costs in the long run as those denied GP care will seek help at A&E instead, the co-authors of the paper warned.

“For conflating administration and treatment, in direct contravention of NHS England guidelines, evidence was found that some practices threatened to withhold treatment until patients provided ID or attended a health check, that patients could only register during one hour in late morning and that patients could not be seen for emergency treatment.

“These restrictions on treatment may endanger patients and divert them into the more expensive emergency department. The alarming suggestion that patients could not be seen for emergency treatment contradicts NHS England guidelines.”

Only 12% of surgeries analysed told would-be new patients how they could go about getting registered even if they did not have the right documents.

One practice’s website said that registration would be delayed unless the person supplied the paperwork. But NHS advice is that patients should be registered and then asked for proof of ID afterwards. Another suggested people could go to a walk-in centre, while two sought a passport, ID card or Home Office correspondence from people newly arrived in Britain.

“Whilst most people will not find it a problem to provide ID and proof of address when registering with a GP, some people – like refugees, asylum seekers, homeless people – do not have these documents,” said Lucy Jones, the director of programmes at Doctors of the World, which runs health clinics for those unable to access NHS care.

“Nobody wants a situation where the most excluded and marginalised people in our communities are shut out of primary care, but this is what happens when GP practices make unnecessary requests for paperwork.”

“In 2018, a fifth of Doctors of the World’s patients were not allowed to register with a GP, most commonly because the person could not provide ID or proof of address.”

The Royal College of GPs admitted surgeries were breaking the rules.

“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,” said its chair, Prof Helen Stokes-Lampard.



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