Unlocking the gate Registering homeless people for NHS primary care Introduction NHS England published a guide to patient registration that set out the standard operating principles for General Practice in November 2015.1 The stated purpose of that document is to provide clarity for General Practitioners and commissioners of primary care with regard to whether patients need to provide evidence of their identity or address as a requirement of registration.
Purpose of this document This document summarises the key points set out in that guidance as they relate to homeless people (or people at risk of homelessness) for the convenience of any interested party, but in particular General Practitioners, commissioners of Primary Care services, and organisations providing support to vulnerable people in Stoke-on-Trent. The guidance makes clear that practices should make every effort to register patients.
Summary Who can register for free primary care services?
There is no set length of time that a patient must reside in the country in order to become eligible to receive NHS primary medical care services Therefore, all people who are homeless, whether lawfully in the UK or not, are eligible to register with a GP practice That is the case even where that person is not eligible for secondary care (e.g. hospital care) services The length of time that the person is intending to reside in an area dictates whether a patient is registered as temporary (24 hours – 3 months) or permanent (more than 3 months)
Immediately necessary treatment
General Practices are also under a duty to provide emergency or immediately necessary treatment, where clinically necessary, irrespective of nationality or immigration status The practice is then required to provide 14 days of further cover following the provision of immediate and necessary treatment
Accessing patient identification at registration
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It is legitimate for practices to apply a policy that asks a patient for identification as part of the registration process Policies should make clear what action to take if the patient is unable to supply any form of identification If the patient states that they reside within the practice boundary but cannot produce any supportive documentation then the practice should accept the registration o Specific examples cited in the guidance include People that are street homeless or in unstable accommodation People fleeing domestic violence
See: NHS England, November 2015, “Patient Registration: Standard Operating Principles for Primary Medical Care (General Practice)”, Primary Care Commissioning, Gateway Reference 04448.
People living on a boat People staying log-term with friends People working in exploitative situations without access to their documents People that have submitted their documents to the Home Office as part of an application Where necessary, the practice may use the practice address to register a patient if they wish However, practices should try to ensure that they have a means of contacting the patient if necessary (e.g. with test results, etc.)
Determining if a patient lives in the practice area
Practices are able to register new patients who live outside the practice area without any obligation to provide home visits or services out of hours It is for a practice to decide, at the point of registration, whether it is clinically appropriate and practical to register the individual patient in that way Patients have a right to change practice if they wish
Veterans
Specific instruction for veterans is set out in the full NHS England guidance document (gateway reference 04448) which should be consulted by practices
People released from prison and/or in contact with criminal justice services
It is important that these patients have equitable access to primary care services As a minimum, the arrangements set out for any other patient should be followed Where the practice has a policy of requiring documentation at registration, then a letter stating that the person has a place to stay from either a Youth Offending Team or Community Rehabilitation Company should suffice
Refusing registration
If a patient is registered with another local practice this is not a reason to refuse registration If a practice refuses any patient registration then they must: o Record the name, date, and reason for refusal o Write to the patient explaining why they have been refused o Do so within 14 days of the refusal o Make this information available to commissioners on request Commissioners may ask practices to submit the numbers of registration refusals including the patients’ age, ethnicity, etc., as part of their quality assurance process
Further information For further information, you can contact the local CCG or NHS England as follows: Primary Care Commissioning NHS England Quarry House Quarry Hill Leeds LS2 7UE
Clinical Director Primary Care Stoke-on-Trent Clinical Commissioning Group c/o Smithfield 1 Building Leonard Coates Way Stoke-on-Trent ST1 4FA
0113 8250912
0845 602 6772
england.primarycareops@nhs.net
NSCCGContactUs@northstaffs.nhs.uk