Sadly, for some of our patients, access to general practice is a real problem, and it shouldn’t be.
But why do some patient cohorts struggle with access? Well, there are multiple factors, and one factor that causes significant issues is the patient registration process.
There’s a common myth about patient registration: that is, that patients must provide proof of ID, proof of address and proof of immigration status when they want to register at a GP practice, otherwise access will be denied.
Well, it seems that, to make general practice more approachable, so that it’s easier for patients to get in through the door, it’s time for me to be a mythbuster!
Please be aware, there is no regulatory requirement to prove identity, address or immigration status to register at a GP surgery. The inability to provide ID and/or proof of address documents does not amount to reasonable grounds to refuse registration.
You may be thinking, “But we’ve always done it this way.” Well, if that’s the case, I’m afraid it’s time to change. Some patient cohorts already face barriers to care, and practice staff must ensure that a lack of ID and/or proof of address doesn’t present another barrier to care. What’s really alarming is that those who are most often excluded from general practice, due to this additional barrier, also die earlier than the rest of the population – so this is a very serious concern.
Many practices insist on proof of ID and address at the point of registration, and this is causing a real problem, as 17% of the population do not hold a passport and only 74% of the population have a driving licence. To make matters worse, many banks and utility companies only offer online statements. There are many barriers that hamper the registration process, and something must be done to make sure patients can register with a practice, without having to prove who they are or where they reside.
The reality is that everyone working in general practice can help, as addressing health inequalities is everyone’s responsibility. So, what can you do? How can you and your team help? I asked Nicola Davies, Director and Founding Member of the Institute of General Practice Management (IGPM), and Olivia Butterworth, Deputy Director of People & Communities, NHSE&I, what they believe can be done to remove barriers and make the registration process easy for all.
Nic said, “Make your registration process as easy as possible. Be aware that some people have literacy issues and consider introducing a ‘registration champion’ to help patients during the registration process; this could be your social prescriber or care coordinator. Don’t get bogged down in the bureaucracy of the process, and remember, ID is needed ONLY for access to online records, and this is totally separate to the initial registration process. Even then, there are other ways to validate someone without requiring photo ID.”
A key comment from Nic is not to get “bogged down in the bureaucracy”; your team isn’t acting on behalf of organisations like HMRC, Immigration or Border Force. If you’re concerned about fraudulent activity, then pass it on to the NHS Fraud team; they can deal with that.
Olivia Butterworth from NHSE&I said, “Remember the power of a friendly welcome; if you create a barrier, you’ll be faced with a barrier. Offer the patient a welcoming and friendly smile, offer them support with completing the registration form, think about involving your social prescriber or care navigator as some patients may need additional support.”
If changing the registration process in your organisation is met with cries of, “But we’ve always done it this way!” or “But you do need ID and proof of address,” it’s time for you to be the mythbuster! However, it’s not only the views of your team that you’ll need to change. Think about your website, your practice information leaflet and your reception / waiting areas; what does it say in these areas? What do you need to change?
Whilst it’s reasonable to ask for patient ID as part of your patient registration policy and process, your policy must stipulate what actions should be taken if a patient is unable to produce ID. Furthermore, asking for photographic ID could be considered discriminatory.
The BLUF (bottom line up front) is that lack of ID and/or proof of address is not a reason to refuse registration.
You’ll be interested to know that we’ve recently delivered a webinar on this topic and we’ll be producing some learning resources in the coming weeks, which will help administrative / reception staff to understand the registration process.
But, for now, it’s over to you to bust those myths and break down those barriers that affect the patient registration process.
Helpful policies:
New Patient registration and health check policy [PLUS]
Access to online services [PLUS]
Access to medical records [PLUS]
March 25, 2022 at 11:28 am
We are responsible for a Special Allocations Service. One person was referred to us because he lost his temper after 3 days of trying to register at a practice. His application was repeatedly rejected because his form wasn’t completed correctly. He is a drug abuser with very limited literacy. We have helped him to get treatment with a practice near his new home and will move him off the SAS in the next few weeks.
March 25, 2022 at 2:35 pm
It is all very well advising patient’s do not need photographic ID and proof of address to register with a gp practice. If someone is registering for the first time and they were born outside of the uk, BSO NI will not process the patient registration and they will not be added to the practice list until they provide photographic ID and proof of address. It is not the practice who insist on this documentation but the department which process the gp registrations in Northern Ireland
March 29, 2022 at 11:01 am
Got rid of the need for ID a long time ago. We are not Border Control nor the police. If a patient states they are who they are and live where they do then that’s all we need to know. The only time for full ID is patient on-line access to register for full medical record access. I don’t request ID for scripts or appointments access. We are not here to police secondary access either so whilst we do what we can to record access to public funds for overseas visitors, it isn’t our responsibility to ensure they have the means when they need the secondary care bit. Until it is a statutory responsibility of Primary Care I don’t see why we enforce this, we will do what we can but we all have increasing work loads to deal with and the less red tape the better.