Anyone in England can register with a GP practice. Under the terms of their primary medical services contracts, GP practices cannot refuse an application to join its list of NHS patients on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability, immigration status or medical condition.
An application can only be turned down if:
- the commissioner has agreed that they can close their list to new patients
- the patient lives outside the practice boundary
- they have other reasonable grounds
In practice, this means that the GP practice’s discretion to refuse a patient is limited.
Seeing ID helps to ensure the correct matching of a patient to the NHS central patient registry. A clear policy on ID as part of the registration process is preferable, which should be clear on the process when a patient is unable to supply any form of ID. Any policy to ask for patient ID should be applied in a non-discriminatory fashion, applying to all prospective patients equally. A practice policy should not routinely expect a patient to present a photograph as this could be discriminatory.
If a patient cannot produce any supportive documentation but states that they reside within the practice boundary, then practices should accept the registration.
Homeless patients are entitled to register with a GP using a temporary address which may be a friend’s address, a day centre or perhaps the practice, noting how to contact the patient when needed (for example with test results).
Most patients will not find it difficult to produce ID / residence documentation. However, there will be some patients who do live in the practice area but are legitimately unable to produce any of the listed documentation. Examples of this may be:
- People fleeing domestic violence staying with friends or family
- People living on a boat, in unstable accommodation or street homeless
- People staying long term with friends but who aren’t receiving bills
- People working in exploitative situations whose employer has taken their documents
- People who have submitted their documents to the Home Office as part of an application
- People trafficked into the country who have had their documents taken on arrival
- Children born in the UK to parents without documentation
Reasonable exceptions therefore need to be considered and the individual registered with sensitivity to their situation. It is important that these people have equitable access to primary care services.
As there is no requirement under the regulations to produce identity or residence information, the patient MUST be registered on application unless the practice has reasonable grounds to decline. Registration and appointments should not be withheld because a patient does not have the necessary proof of residence or personal identification. Inability by a patient to provide identification or proof of address would not be considered reasonable grounds to refuse to register a patient.
The BMA is encouraging practices to consider use of the Doctors of The World Safe Surgeries Toolkit.
The toolkit – endorsed by RCGP and RCN – is an accessible presentation of existing DHSC and NHSE guidance and supports clinical and non-clinical NHS staff to promote inclusive care through GP registration.
Who Can Register for Free Primary Care Services?
A patient does not need to be “ordinarily resident” nor in the country for any set length of time to be eligible for NHS primary medical care –this only applies to secondary (hospital) care.
Therefore, all asylum seekers and refugees, students, people on work visas and those who are homeless, overseas visitors, whether lawfully in the UK or not, are eligible to register with a GP practice even if those visitors are not eligible for secondary care (hospital care) services – referral to secondary care should be decided on clinical grounds alone. The length of time that a patient is intending to reside in an area dictates whether a patient is registered as a temporary or permanent patient. Patients should be offered the option of registering as a temporary resident if they are resident in the practice area for more than 24 hours but less than 3 months.
Refugees and Asylum Seekers Registering at your Practice
Please click here to view Refugees registering at your practice
When registering children, there are additional circumstances that practices should be aware of, in relation to safeguarding guidance.
The legal definition of a child is 0 to 18 years of age; however young people may be able to make independent decisions from as young as 12, depending on the circumstances. Section 11 of the Children Act 2004 places a statutory duty on the NHS to safeguard and promote the welfare of children. The Victoria Climbie Enquiry Report 2003 (9.104) stresses the importance of GP registration for every child. It sets out the importance of knowing the identity of those registering the child and their relationship to that child.
If a child under 16 attempts to register alone or with an adult that does not have parental responsibility, the Practice Child Safeguarding Lead should be alerted.
For purposes of safeguarding children, the following should be considered whilst recognising that patients must still be registered in the absence of documentation and policies must be applied in a non- discriminatory manner.
The practice should seek assurance through:
- Proof of identity and address for every child, supported by official documentation such as a birth certificate (this helps to identify children who may have been trafficked or who are privately fostered).
- An adult with parental responsibility should normally be registered at the practice with the child. The ID of the adult is useful as it can be matched to the birth certificate details. However, the practice should not refuse to register a child if there is no-one with parental responsibility who can register, as it is generally safer to register first and then seek advice from the Safeguarding Practice Lead, Health Visitor or Practice Manager. (This situation may alert you to a private fostering arrangement which constitutes a safeguarding concern.)
- Offering each child a new patient registration health check as soon as possible after registration.
- Seeking collaborative information (supported by official documentation) relating to:
- current carers and relationship to the child;
- previous GP registration history;
- whether the child is registered with a school and previous education history;
- previous contact with other professionals such as health visitors and social workers.
- Children who have been temporarily registered with the practice should be reviewed regularly and proceed to permanent registration as soon as possible and ideally within three months of initial registration. Likely length of stay should be determined at initial registration and patient registered as temporary/permanent, as appropriate.
- Children of parents or carers who have been removed from the list for any reason must not be left without access to primary care services.
- Where parents or carers have been removed from the list due to aggressive and/or violent behaviour, a risk assessment should be completed to identify any risk to their children and the appropriate referrals made.
Practices should be alert to potential risks such as those described above when young people aged between 16-18 years of age register alone and dealt with in line with practice safeguarding procedures and escalated outside of the practice through the local procedures if appropriate.
Working Together to Safeguard Children – A guide to inter-agency working to safeguard and promote the welfare of children
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 required to provide 14 days of further cover following provision of immediate and necessary treatment.
A person visiting your practice area is entitled to be registered as a temporary resident if they intend to stay for more than 24 hours, but less than 3 months. Less than 24 hours, they should be treated as Immediately Necessary and if staying for longer than 3 months, they should be permanently registered.
Many patients register as a temporary resident to obtain medication. With the advent of Electronic Prescribing Services (EPS) it is now possible for a patient to ask for their repeat prescription from their permanent registered surgery to then be “sent” to a dispenser where they are temporarily away on holiday and many will have access to the NHS App or their surgery website in order to do this.
It is best to inform them of these preferred options but if nonetheless they express a need for their medication, then the temporary GP should put themselves in a position to judge whether a prescription is necessary. If a GP is uncertain about the genuine nature of an urgent request, they may wish to prescribe a short course only whilst enquiries are made with their home practice.
Special care should be taken regarding benzodiazepines and analgesia. See our section on Counter Fraud – Drug Seekers.
If, however, the person is only in the area for less than 24 hours they can be provided with immediately necessary care or, if not urgent, then they can be refused and told to see their own GP upon returning home. This will depend on clinical judgement.
Q: Is it worth filling in the forms for temporary patients?
A: Yes, probably
Although payment for temporary patients is part of the global sum, the forms you fill in will inform the current level of services provided to temporary residents and will help to determine any adjustments to global sum payments should this be necessary. It is important therefore to record all non-registered patients who are treated, including those requiring emergency or immediately necessary treatment.
Annex C of the GMS Statement of Financial Entitlements Directions sets out the basis for temporary resident adjustments.
Registration of Those Previously Registered with Defence Medical Services (DMS) and Priority NHS care for Veterans
DMS have their own GP services that look after serving personnel, mobilised reservists, and some families. These primary care services are commissioned separately by NHS England. When servicemen and women leave the armed forces, their primary healthcare reverts to the responsibility of the local NHS. As a minimum requirement the arrangements set out above in respect of the registration of any patient with a GP surgery should be followed when the person registering is a veteran. Prior service should be recorded on registration and allocated the correct Read/Snomed Code.
This should enable access to specialist care or charity support as necessary for such patients. A veteran is an ex-service person or reservist who has served in the armed forces for at least one day. There are around 2.5m veterans in England at the time of drafting. All veterans are entitled to priority access to NHS hospital care for any condition if it’s related to their service (subject to clinical need), regardless of whether or not they receive a war pension.
All people leaving the armed forces are given a summary of their medical records, which they are advised to give to their new GP when they register. The practice will also be advised of prior registration with Defence Medical Services and with a summary of their in-service care. More information on the duty of care owed to service personnel is contained in the armed forces covenant which can be found here; the_armed_forces_covenant.pdf (publishing.service.gov.uk)
Also see our webpage: Registering Armed Forces Personnel
Persons Released From Prison and/or in Contact With the Criminal Justice System
As a minimum requirement the arrangements set out above in respect of the registration of any patient with a GP surgery should be followed when the person registering has just been released from prison or young offenders institute and/or is in contact with the criminal justice system. It is important that these patients have equitable access to primary medical care services. This patient group MAY produce a letter from either the Youth Offending Team or Community Rehabilitation Companies (CRC) stating that they have a place to stay, this letter should suffice for registration purposes under the category ‘documentation from a reputable source’ where the practice has a policy of asking for documentation at registration (noting, of course, that a lack of proof of ID is not an acceptable reason for refusal to register).
Contract changes in 2017/18 mean that people can register with a GP Practice prior to their release from secure residential estates (such as prisons, young offender institutions, immigration removal centres and secure training centres). NHS England have produced a one page flowchart guide to assist practices in this process. For queries, email email@example.com
If a practice refuses any patient registration, then they must record the name, date and reason for the refusal and write to the patient explaining why they have been refused, within a period of 14 days of the refusal. This information should be made available to commissioners on request. Commissioners may ask practices to submit the numbers of registration refusals, age, ethnicity, and reasons as part of their quality assurance process. For purposes of clarity – it is not acceptable to refuse to register a patient because they are registered with another local practice.
June 2022 – NHSE published a letter and two service specifications setting out expectations and support around GP registration and the management of the initial health needs for individuals and families coming to England fleeing the conflict in Ukraine.
To ensure there is a robust approach to identifying individual’s initial health needs (both for all current and future arrivals) NHSE are asking all systems to locally commission additional capacity for delivering robust initial health assessments. Assessment of any safeguarding concerns will be a key priority alongside assessment of health needs, keeping people safe and taking appropriate actions to prevent harm. NHSE have also produced bilingual versions of the GMS1 form which are now available on the DHSC website.
Digital Online “Register with a GP Surgery” Service
The “Register with a GP Surgery” service gives all GP practices in England a standardised way of taking registrations online. It makes it simpler and more accessible for patients to register with a GP and easier for practices to manage registrations.
The service is designed and run by NHS England and is free for NHS GP practices to use. Find out more and sign up on NHS Digital at Register with a GP surgery service – NHS Digital
There are a number of resources available on the FutureNHS platform
NHSE say the benefits include: –
- Integrated with the NHS App and ‘Find a GP’ improving discoverability
- NHS number matching – 92% match success rate reducing time to identify patients
- Patient’s identity validated through NHS login
- Data validation – reduced PCSE exceptions – Nationwide was x3 higher than our service which was only 1.1% (April’23)
Catchment Area Checks
- Integrated with eDEC to support practice catchment area policy
- Practices can accept or reject registrations
GMS1 / Registration Forms
Many practices currently use a GMS1 form and a new patient health questionnaire when patients request to register. it is not a requirement to use the GMS1 form and you can design your own or incorporate into your new patient health questionnaire. However, all the information that is on the GMS1 form must be included within any new form/questionnaire. The supplementary questions must be embedded; they are not compulsory but if answered by the registering patient, then copies of the form must be submitted – see gms1-form-guidance-for-gp-practices.docx (live.com) for details.
From 2023 the digital service – Register with a GP surgery service will be available. It has been designed to make it easier and simpler for people to register including those from vulnerable groups.
From July 2023, patients transferring GP practice will receive confirmation that their registration has been successful via a new Notify a Patient service. It aims to reduce GP admin burden by reducing the number of calls or visits from patients to confirm their registration status and is set to be rolled out for the majority of registrations by the end of the year. Confirmation is sent via NHS App, email, SMS or post.
Wessex LMCs has developed some suggested templates that you may wish to use. These are in a word format so that you can customise them, just click on the relevant link below to access them:
(includes specific details for Dorset Care Record, Hampshire CHIE, SystmOne and EMIS which can be deleted as applicable)
We would like to thank the Grove Medical Centre and Arens Healthcare Informatics for sharing their registration forms and Caroline Sims & Helen Williams for their valuable input on sharing medical information.
Blood and Organ Donations
Patients should record their preferences directly through the blood and organ donation online registration websites, or by phone:
- Blood donation: https://www.blood.co.uk
- Organ donation: https://www.organdonation.nhs.uk
- Blood or organ donation by phone: 0300 123 23 23
Note that organ donation is now an “opt out” process. There is more about this on the organ donation website.