Practice staff concerns can pose an obstacle for patients who do not have documents for registering, a new study has found.

The current NHS guidance for England states that anyone who is resident in the country is eligible to register with a GP, however most practices ask for proof of address and identification as routine. Those without the requested documentation are often refused registration, previous research has shown.

Dr Kitty Worthing of Queen Mary University of London, UK, and her team write in British Journal of General Practice that “staff attitudes and practice regarding registration of those without documentation are under- researched”. They gathered information from three clinical commissioning groups in North East London, interviewing 33 GP staff participants and holding focus groups.

Analysis found that, despite good knowledge of the guidance, “most participants expressed reluctance to register those without documentation, often introducing additional hurdles or requirements in their everyday practice”. It was inferred that “those without documents were perceived as burdensome, and/or that moral judgements were made about their deservedness to finite resources”, the researchers state. The staff participants highlighted concerns over workload and funding, with some having the view that GP services should be restricted by immigration status.

“Improving inclusive registration practice requires addressing staff concerns, supporting navigation of high workloads, tackling financial disincentives to registering transient groups, and challenging narratives that undocumented migrants represent a ‘threat’ to NHS resources,” the authors write. They also point to “upstream drivers, in this instance the Hostile Environment”