Viewpoint: Why we decided to become a 'safe surgery'

Safe Surgeries, an initiative run by charity Doctors of the World, aims to tackle the barriers faced by vulnerable people in accessing healthcare. Dr Elizabeth Gonzalez and Jamie Kerr explain why their practice decided to take part in the scheme and what this involved.

Dr Gonzalez (left) and Jamie Kerr

Everyone living in the UK has the right to register with a GP. This reflects the fundamental principles upon which the NHS was founded and vital to promoting universal healthcare coverage.

Thursday 12 December is International Universal Health Coverage day. This is a global campaign arguing that every person, no matter who they are or where they live, should be able to get the quality health services they need without facing financial hardship.

GP services can fundamentally improve health across the community. Through a patient-centered approach and a focus on prevention, we provide equitable care for all, connecting local communities with the NHS.

Access to primary care is crucial to ensure healthcare becomes truly universal and accessible to all. According to NHS guidelines, everyone can register with a GP. Yet, patients are still wrongly refused registration in practices across England. As a super partnership in Birmingham, one of Britain’s most diverse cities, we were stunned to realise that people in our community were being excluded from healthcare.1

Barriers to registering with GP practices

A year ago, we attended a local event run by Doctors of the World UK on access to primary care. We were shocked to hear the barriers to registration people in Birmingham and around England had to face.

A local Roma family described how difficult it had been to access healthcare for their family and children. The mother had to travel all the way to London while pregnant to be able to access antenatal care. And their case is not an isolated one: almost one in five attempts by trained volunteers to register patients in vulnerable circumstances with GP practices are wrongly refused.

This is not what medical professionals want: every decision we make is for the benefit of our patients. Yet despite NHS guidelines, many practices ask for proof of ID and address when a patient asks to register. This excludes many people who are already in difficult circumstances, such as those experiencing homelessness, refugees, asylum seekers and migrants who might struggle to provide these documents.

We felt that something had to be done. Our partnership counts 10 surgeries across Birmingham, providing care to over 64,000 patients both in the north and south of the city. With this reach, we knew we could make a big difference for patients struggling to register with a GP across the community.

Becoming a Safe Surgery

We decided to sign up to Safe Surgeries, an initiative run by Doctors of the World. Becoming a Safe Surgery means committing to taking steps to tackle the barriers faced by vulnerable people in accessing healthcare. With a few changes in practice, we could make a difference and ensure no one in our community was excluded. 

From management to GPs and frontline staff, everyone in our partnership was excited and ready to implement this model. The Safe Surgeries toolkit provided concrete and simple steps practices can take to promote equal access.

It allowed us to educate staff about barriers to registration they might have not been aware of and formalised our registration process providing an identifiable brand under which we would operate. Now, when a patient asks to register with us, staff can say 'We’re a Safe Surgery. We don’t ask for ID or proof of address, this is our policy. You are welcome here'.

Joining this network has been very empowering for our staff and our entire partnership. From the beginning, our objective has always been to register patients and ensure they receive healthcare safely, no matter where they come from or who they are.

The impact on staff and patients

Now that we have been a Safe Surgery for over one year, we can see the difference it has made to our patients and staff. Our practices have become more diverse and staff have all the tools they need to help patients register. The whole team has pulled together to do what is best for the patient.

The biggest worry for GP practices is the pressures currently placed on primary care. Taking part in Safe Surgeries however, did not increase workload, but instead simplified our work. 

Implementing it was almost seamless. With a few tweaks to the way we register patients – whether amending registration forms or training staff – we managed to achieve this across a large provider group with multiple sites. Now, Safe Surgeries is normal practice. Any surgery should and can do this, for the good of our patients.

Everyone is entitled to healthcare in this partnership, in this city, and in this country. Access to healthcare is the priority – all patients come first, no matter what ID or proof of address they have.

This is key to striving for universal healthcare coverage, and it makes sense from a public health and financial perspective. If diseases are not treated straight away within primary care, they might escalate and potentially become life threatening. We need to ensure access to primary healthcare for everyone.

  • Dr Elizabeth Gonzalez is a GP partner and Jamie Kerr is senior regional officer - business at Midlands Medical Partnership. Both have an interest in service redesign and health service delivery to vulnerable populations.

Further information

  • There is more information on Doctors of the World's Safe Sugeries initiative here.


  1. Doctors of the World UK. Registration Refused: a study on access to GP registration in England. Update 2018. Published 2019. Available at

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