Access to Primary Care in a ‘Hostile Environment’


It’s always frustrating to start in a new place without having all the paperwork or ‘life admin’ sorted. I moved to Northampton six weeks ago to start a GP placement and I’m just beginning to settle in. Incidentally, along with my colleague Rose Glennerster, I’ve been investigating the barriers faced by people who want to register with a new GP surgery. The administrative burden placed on people who need medical treatment is high and even as a doctor who is used to the hoop-jumping of the NHS it is off-putting. Some GP practices are making it particularly difficult for people who are new to the UK or live in temporary or rented accommodation.


This should not be the case. Here’s what the Care Quality Commission says about access to GP practice:


“No documentation should be required in order to register with a GP. Overseas visitors have no legal obligation to provide proof of identity or immigration status; however, asylum seekers may be able to provide an ‘application registration card’ (ARC) provided by Immigration Services”.


I’ve written much more about the problem over at the BMJ Medical Ethics Blog. Here’s the key paragraph:


What we do not know is whether confused receptionists are denying registration to more patients or whether patients themselves are being confused out of registering. What is clear is that a well-publicised hostile environment in NHS hospitals has coincided with an increase in the number of asylum seekers, refugees and unlicensed immigrants being refused GP registration (particularly for reasons based on immigration status and gatekeeping behaviour) and that some GP practices are mistakenly denying registration to people without specific documents and declaring this policy on their websites. Somewhere along the line, many people who are entitled to primary care come to believe that they are not.


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