Some information about registering patients in English GP settings

What's happening, and why is it a problem?

For various reasons GP surgeries are misinterpreting guidance from NHS England. This is discriminatory and potentially harmful.

(1) Registering a new patient is easier if the surgery can be sure the person is who they say they are. GP surgeries mostly have to register anyone within their catchement boundary who applies, but have discretion to register patients who live outside the boundaries. Both of these mean that GP surgeries like to ask people to supply ID documents. If they ask for ID they have to ask everyone for ID - not doing so is discriminatory.

Some surgeries have misinterpreted this as a requirement to check ID. They are wrong. Some groups of people will not be able to provide ID. This might include women fleeing domestic violence, or homeless people. Forcing patients to provide ID before registration means these groups will not be able to register. GP surgeries that force people to provide ID risk breaking the Equality Act 2010.

(2) Everybody in England can register for free GP care. But some people will have to pay for secondary care. GPs have to warn people that they may be charged for some treatment.

Some Surgeries have misinterpreted this. They think that they have to determine who is eligble for free NHS treatment, or that some people in England can't get free GP treatment. This is incorrect. Everyone in England can get free GP treatment. When a patient is referred by a GP for further treatment it is the responsibility of the recieving organisation to check eligibility for free care, not of the GP. The GP should only make decisions based on clinical reasons.

(3) Some surgeries are refusing to register children unless a full original birth certificate is provided. They will say this is to protect against child trafficking or kidnapping. They have misinterpreted the guidance. It is important that children are registered with a GP, even if they do not have a birth certificate. If a child tries to register and cannot provide ID or a birth certificate they should be registered and the safeguarding lead for the surgery should be told.

How is it happening?

I genuinely do not know. I think that boiler-plate text in websites supplied by vendors to GP surgeries contains incorrect text. I've tried to ask a few website suppliers about this, but I haven't had any answers.

I think there's also something about the PCSE guidance which talks a lot about the need to identify patients, but not so much about the need to register patients even if they cannot supply ID.

I've asked a few CCGs about it, and they all know what the guidance is and they keep telling GP surgeries.

List of further reading

How to register with a GP practice This NHS England website is clear and easy to understand. The leaflets are particularly good.
Primary Medical Care Policy and Guidance Manual. You need to read section 8, starting on page 141.
PCSE Registration Guide This is a complex document aimed at people working within GP surgeries.
PCSE Registration website This is the website of the PCSE, who handle (among other things) registering patients. It's useful to look at "How do I register a homeless patient?"
How to Register with a GP? This is a nice, clear, NHS England leaflet. It contains info about ID (it's not needed but makes things easier), and the need to register homeless patients
Homeless PatientsThe same leaflet but tailored for homeless people.
Asylum seekersThe same leaflet but tailored for asylum seekers.
An old BMA page about patient registration
CQC Guidance about looking after homeless patients