As GPs, we know how crucial it is for individuals to be able to see a doctor or nurse when they need to. It’s in our consultation rooms that we can support a patient with mental health difficulties, help manage chronic conditions, provide immunisations and screening as well as enabling early diagnosis of serious illnesses.
However, this essential care is not accessible to many people living in our communities: a recent report by Doctors of the World UK (DOTW) showed that almost one in five of their attempts to register patients with a GP are wrongfully refused by GP practices.
These findings raise serious concerns for public health and individual wellbeing, but also signify potential discrimination at the frontline of our NHS. Everyone in the UK is entitled to register and consult with a GP, free of charge.
The refusals are especially worrying because those who are turned away are some of the most vulnerable people in our communities – they include people experiencing homelessness, migrants in vulnerable circumstances, victims of trafficking and asylum seekers.
Conscious of these issues, many GP practices are taking steps to ensure that their services are as open and welcoming as possible. And a little can go a long way.
In England, over 200 practices have signed up to the Safe Surgeries network, committing to taking steps to tackle the barriers faced by many migrants and homeless people in accessing healthcare.
I myself only came to realise how harmful the barriers to accessing primary care were when I started volunteering at the DOTW clinic in east London.
On average, DOTW’s patients have been in the UK for six years without seeing a GP, often having been turned away before seeking our help or being too afraid to approach a GP practice themselves. It’s hard to see this from the busy consulting room, but it does happen regularly in many practices at the reception desk or online.
The most common reason for patients being refused registration is not being able to provide paperwork, such as proof of address and proof of ID. This especially affects rough sleepers or people living in unstable accommodation, as well as people whose exploitative employers have withheld their documents or those fleeing violent situations.
Often practices requesting these documents don't realise that according to NHS guidelines, they are not required to do so and that they shouldn’t refuse to register someone just because they can’t provide them. Raising awareness among reception teams and with other GP surgeries regarding this can make the single biggest difference for people who need care.
Empowering frontline staff with training and an inclusive registration policy can also have a transformative effect. For example, patients might be afraid to share their home address or immigration status with a GP practice, fearing that it could be used by the Home Office to track them down.
This is a well-founded fear, as until recently patient records could be used for immigration enforcement purposes. While this policy changed last year, data-sharing still takes place in secondary care and many patients are understandably fearful of their details being passed to the Home Office. By training frontline staff about this and other barriers, and creating appropriate pathways, we can support vulnerable patients.
Informed frontline staff also go a long way towards creating a welcoming environment, and open up the potential for using social prescribing to connect vulnerable people with non-health services they desperately need. Housing advice, immigration advice and local community groups that help build social networks can make all the difference.
Finally, the availability of language interpreting and translation, both at reception and in consultations, is crucial if a patient has difficulty communicating in English.
The NHS and general practice are under great strain, but reducing access to essential primary care and prevention of further ill health isn’t going to help.
Reducing barriers to access doesn’t have to be difficult and changes involving reducing paperwork and having a more welcoming attitude, are often welcomed by reception teams. A few key steps can make a huge difference for so many people that might otherwise remain invisible to the health services they’re entitled to use.
Safe surgeries constitute a step towards a truly equitable and non-discriminatory primary care system.