Eligible patients are being unlawfully refused GP registration across the UK 

It is an understandable assumption to make that all people who are legally entitled to NHS primary healthcare are able to register at a GP practice. However, it may be surprising to discover that several groups of patients are being frequently refused GP registration through no fault of their own. Patients who do not have a permanent home address, as well as those without a valid ID, are being unlawfully turned away at the point of registration. 

The most commonly affected groups include people experiencing homelessness, asylum seekers, victims of human trafficking and nomadic communities – groups that already have higher rates of socioeconomic vulnerability than the rest of the population. Experiences like this can have immense consequences on a patient’s wellbeing. It is easy to imagine the anxiety that being left without any medical support could cause, as well as the anger and frustration of being the victim of a system that is deeply unfair and not fighting your corner. 

Some patients who are unlawfully denied registration may get the impression that they are simply not entitled to primary healthcare and give up trying altogether. I have personally met boaters with this belief who have not seen a GP for years in spite of troublesome symptoms that are treatable in primary care. 

Patients who are refused registration but fight for their rights often find that no matter what they do or who they contact for support, nobody helps them with their attempts to be registered. Joy is one of those people, whose story truly highlights the deep structural failings underlying this issue.

“For over twenty years I have been living aboard a narrowboat, and for the majority of that time I have been a ‘continuous cruiser’. A continuous cruising licence requires me to move a minimum distance every fourteen days. As a result of this, I have no fixed address. According to the NHS and Primary Care Support England, I am able to register with a GP surgery without a fixed address. In reality, this process has been almost impossible for me to carry out.

In March 2022, I intended to register as a temporary patient at a local surgery due to worrying breast pain. I was told to register permanently as I would require an urgent hospital visit. My lack of address meant I was treated as if I were homeless using the practice address.

In September 2022, the practice then informed me that I could no longer use their address for registration. They offered two options: provide an alternative address or be removed. 

Being in the position of receiving ongoing care from the hospital, and treatment for a lung infection, I felt pressured and anxious to rectify my situation. The only other address that I could give at the time was my mother’s house in Wiltshire. I offered this, explaining that it was postal only and that I did not live there. Following a brief face-to-face meeting with the practice manager, they informed me that they would not accept this and would therefore remove me from the practice. Despite writing several letters, emails, and contacting my local MP, nothing changed.

In November 2022 I made a formal complaint to NHS England after I was officially removed from the practice, whilst still receiving hospital treatment. Unfounded claims about my behaviour were then cited by the practice manager in response to this complaint. This caused me immense distress, and I felt stripped of my agency.

It took six months before I could face the prospect of registering at another practice despite needing medication for hypertension previously diagnosed at the last practice. I did this, only to be removed a few months later – again due to the address issue. On 24 April 2024, one year and five months after my complaint, NHS England ruled against me.

The struggle left me exhausted and deeply depressed, unable to access the care to which I was entitled purely because I had no address, with nowhere left to go for resolution. Having worked hard all of my life, discrimination weighed heavily on me with the poor treatment I had received from those charged with my care.

Consequently, it was a full year before I could face registering again, this time using my daughter’s address 50 miles away. It is not ideal. With the cost of dog day care in addition to mileage expenses, the effort involved makes it easier to ignore symptoms that should probably be addressed. Going into my 70th year, I do worry about my healthcare under these circumstances.”

Alongside people like myself and Joy, several organisations have been campaigning against this systemic discrimination for many years, though there has only been modest success. However, there has been very little meaningful response at a policy level to address the structural factors causing the problem. Perhaps this is because the issue is complex – issues stem not only from practices failing to follow guidance, but also from responsible organisations failing to hold practices accountable. National policy, while clearly stating that patients should not be refused registration due to lack of home address or ID, may itself be too open to misinterpretation by highlighting the ‘importance’ of these documents in the registration process. All these factors should be addressed if sustainable improvements here are to be made. However, given that patients’ right to healthcare is being compromised, we feel this warrants action as a top priority.

The Health Equity Evidence Centre team has reviewed the evidence of the problem and set out what needs to change. We have been in contact with organisations linked to general practice to discuss this issue, including Integrated Care Boards and the Care Quality Commission regulating body. Finally, we are taking these issues directly to Parliament. Our evidence and Joy’s personal case study have been submitted to the upcoming All-Party Parliamentary Health Group meeting on improving access to primary care services. We have also been in discussion with local MPs as well as ministers in the Department of Health and Social Care.

This blog accompanies our editorial published in the British Journal of General Practice which you can access here.