Barriers to GP registration in Haringey
Most people in Haringey, and more widely across England, take it for granted that they can register with a doctor or General Practitioner (GP) and receive free healthcare from the NHS. But for those who are unable to show ID or proof of address, including the homeless and people from migrant communities, this isn’t currently the case.
NHS guidance states that there is no requirement to prove identity, address, immigration status or an NHS number to register as a patient, but Healthwatch Haringey has found proof of address and ID are routinely required by GP surgeries across the borough.
Healthwatch Haringey and Haringey Welcome partnered with the NHS, Haringey Council and Doctors of the World to find out how many Haringey GPs will accept a patient without ID.
39 surgeries were called in the mystery shopping telephone survey
- 24 out of 39 said they needed to see proof of address.
- 30 out of 39 surgeries said they needed to see ID.
39 surgeries were visited in person*
- 20 out of 37 required proof of address.
- 20 out of 37 required ID.
(*One would not answer questions, one was closed, so 37 were surveyed).
Further barriers to GP registration
Our research showed Haringey residents face other hurdles to registration with a GP.
- When mystery shoppers visited Haringey GP surgeries, they found four surgeries who would only allow online registration, meaning that people who could not access a smart phone or computer were excluded.
- The in-person mystery shoppers found only 11 surgeries offered any kind of help with completing the registration form, such as interpreting or translating the form into a community language, or offering help from staff who could speak the patient’s language.
- We sometimes found it difficult to get through on the phone. We waited over 20 minutes for a member of staff to answer the phone at seven surgeries.
Key findings
- Staff gave conflicting answers on the different registration methods available at each surgery.
- Nine surgeries told Healthwatch Haringey they did not require the new patient to be living in the catchment area.
- Most people who live in Haringey must produce an identity document (ID) before being allowed to register at a GP surgery.
- Most people in Haringey must produce proof of address before being allowed to register at a GP surgery.
- 10% of GP surgeries in Haringey told us on the phone they would register a patient without seeking proof of address or ID. But the in-person mystery shoppers found 32% of surgeries would register them without documents.
- When we called as Healthwatch Haringey, only two surgeries who had initially asked for documents subsequently clearly answered that they would register a patient without documents if the patient couldn’t provide them.
- Support for people with English as a second language was offered much more frequently by phone when speaking to the Healthwatch Haringey caller than in-person to the mystery shoppers.
- Very few surgeries asked verbal questions about immigration status, but there was a degree of confusion about the need to complete the ‘supplementary questions’ on residency.
- Over half of the surgeries answered the phone in three minutes, but we waited over 20 minutes at seven surgeries.
- Our in-person mystery shoppers noted friendly and welcoming reception staff in 22 surgeries
- Our in-person mystery shoppers found some reception staff were not able to answer all the questions or were unhelpful.
Key recommendations
Our recommendations are based on national research, our own findings, and the good practice we have seen in Haringey. Practices who act on these recommendations will be helping to make sure that people in vulnerable communities have access to the healthcare they need.
Key recommendations for GP practices
- Practices should remove the requirement for ID and proof of address when registering new patients
- Practices should brief all reception staff regularly that failure to provide documents should not prevent patient registration
- Practices should consider inviting Healthwatch Haringey to deliver our 30-minute online briefing for practice staff on removing barriers to patient registration
- Practices should ensure reception staff are aware that immigration status should have no impact on access to GP services, and that anyone in England can register with a GP
- Practices should assure reception staff that they will not be held personally liable for any consequences of incorrect information being supplied by patients
- Practices should engage with Doctors of the World with a view to accessing training and becoming a Safe Surgery
- Practices who are already committed to becoming a Safe Surgery should clearly display posters and leaflets
- Safe Surgeries should offer new and existing staff regular training and / or reviews to ensure all staff understand their responsibility to remove barriers to registration
- Reception staff should be made aware of the resources available for translation / interpretation when registering new patients, and should always offer these when requested by a new patient who seeks help with the registration form
- Practices should ensure through training that all staff are aware the residency questions on the GMS1 form are optional
- Practices should consider enabling the new ‘Register with a GP surgery’ system for online registration as a way to make it easier for people without documents to register
- Practices should ensure through training that all reception staff are aware of the different methods of registration offered at their surgery. Practices who do not offer in-person registration with a hard copy form should consider if this represents a barrier to registration for the digitally excluded
- Practices who only allow patients who live in the catchment area to register should consider making an exception for people who are homeless
- Practices who took a long time to answer our calls should review their staffing and telephone systems
- Practices should ensure all reception staff are aware of the role of Healthwatch Haringey
Key recommendations for the NHS
- The most effective way to remove barriers to registration would be for the NHS to state clearly in guidance that GP practices should not request ID or proof of address
- Hospital Accident and Emergency should offer pro-active support and advice about registering with a GP
It is unacceptable if we have people in our borough, which has quite a high “churn” in its population, that anyone faces difficulty in access to a GP. It is in all our interests that everyone in our community has access to a GP, whoever they are. It’s clear from our checks that some GP practices have been wrongly applying rules and creating obstacles for some. We hope that those practices will now work with us to ensure that everyone can register as patients in future.
Causes of staff failure to register – a complex picture
We looked at research carried out by other organisations into the causes of the refusal to register without documents and we produced an anonymous online survey for Haringey reception staff.
- An overarching lack of resources in the NHS, particularly lack of staff charged with reception duties and the consequent unmanageable workloads.
- Contradictory NHS guidance - e.g. a ‘gatekeeping’ role and liability for collecting correct patient information
- Inadequate support for frontline staff including administrative barriers in the NHS system
- The ‘hostile environment’ including concerns about ‘deservingness’ for some groups
- Concerns that patients without documents are more burdensome
- Perceived risk of fraud leading to potential issues around e.g. patient safety
Resources for Haringey residents
We have developed digital and print materials to help people understand their rights to register with a GP in Haringey. A leaflet and poster entitled ‘Do you need to see a doctor?’ was co-produced with NHS North Central London Integrated Care Board (NCL ICB), Haringey GP Federation, Doctors of the World, Haringey Welcome, Haringey Council and voluntary sector partners.
These leaflets and posters are available in English, Turkish, Spanish, Polish, Bulgarian and Somali. The electronic versions are available to download on the Healthwatch Haringey website.
If you would like free copies of these posters and leaflets please contact us:
tanya@healthwatchharingey.org.uk
07735 143528
