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This guide is designed for residents and migrants, surgery staff and local representatives. It provides a simple overview of your right to register with a GP surgery, so that you can help yourself and others to access treatment. The guidance applies to England.
Which of the below do you think you need to access a GP surgery in England?
The answer is: none of the above. Patients do not need any form of documentation to sign up to a GP surgery in England. This is true whether you are registering digitally or in person.
While there may be a cost for prescription, the care and treatment you receive at a GP surgery will always be free. Any additional costs will be discussed with you, and it will be your choice whether to purchase recommended medications.
No one should be turned away from registering at a GP surgery anywhere in England, including undocumented migrants.
Unfortunately, barriers to healthcare access still exist. Staff at GP surgeries are often overworked and overwhelmed by complicated regulations. You may be asked for proof of address or documentation on arrival at the surgery. It is important that you know your rights – you do not need to provide this.
Many practices have committed to ensuring that nobody in their community is excluded from registering and receiving treatment. This includes finding solutions to language barriers. These are designated ‘Safe Surgeries’ and some will display this in the reception area or on their website.
If the surgery you want to register with does not evidence that it is part of the Safe Surgeries scheme, do not worry. You can still sign up with this GP surgery.
The receptionist at the surgery may ask for your postcode to check that you live within the practice’s catchment area. This is to ensure that you can receive the full range of treatment and care you are entitled to, such as referrals to specialist services in the area. You can tell the surgery staff your postcode without giving proof.
Digital registration platforms, which require patients to provide their details online, are becoming more popular. If you are asked to register digitally, be aware that the information these platforms request may vary. Some will ask for proof of address or ID. This does not change your rights. Speak to reception staff about how to register without providing this documentation.
Many people are entitled to free prescriptions such as those on certain benefits, people who are pregnant and those with certain medical conditions. If you don’t fall into one of these categories you may still be able to get free prescriptions if you are on a low income by filling in an HC1 form to obtain an HC2 form. This will also give you entitlement to NHS glasses and dental treatment. Immigration status is not relevant to this entitlement.
Remember, you have the right to register without providing ID, proof of address or your immigration status.
NHS England guidance states that patients without documents must not be turned away from registering with a GP surgery. Proof of identity or address are not mandatory conditions for registration (Primary Medical Care Policy and Guidance Manual (PGM)(v3) 2021).
In practice, the policy is widely misunderstood as staff face information overload and complex, detailed communications about any policy changes. Staff report concerns that registration takes longer without proof of address, and applications may be rejected by Primary Care Support England. This is unfounded. Improved clarity and support for frontline staff who manage registrations is essential. The system leaves too much up to interpretation. The lack of support means that incorrect processes are systemic, with new staff trained to incorrect guidelines in some cases.
In short, staff are inundated with information, with few avenues to seek assistance or troubleshoot problems in the immediacy. There should be an NHS helpline to support registration queries.
A direct quote from a member of staff at a London GP surgery below:
“I think if people just knew the process, and they could follow it, it’s as easy as that. But it’s so shrouded in, you know, almost irrelevant stuff that it becomes so difficult to then put into practice.”
Primary care services face multiple, overlapping pressures, particularly in terms of staffing resources and retention at all levels. Improved staffing levels would allow time for staff to spend with vulnerable patients to guide them through the registration process and find solutions to communication barriers.
The recording of rejections based on asking for ID or proof of address is skewed because some prospective patients will be asked for this documentation and then not return, without this being marked as a rejection from the service. It is vital that patients understand that they can register without these documents. There are, of course, practical reasons to ask for proof of identity and address when patients present at the surgery. These include confirming that the patient lives within the practice’s catchment area and facilitating the transfer of medical records. Still, it is not permitted to refuse a patient for failing to provide proof.
Digital registration platforms are growing in popularity. Benefits include the elimination of human error, and the assurance that all patients are asked the same question. These platforms are not standardised and may include the request for ID or proof of address. Ideally, there would be a simplified, centralised online NHS system for registration. Surgeries should take care to ensure that systems do not act as a barrier to certain groups and that there is always an option to speak with a staff member.
The GMS1 form must be redeveloped: some GP surgeries operate under the impression that all sections of the form are mandatory. It should be clear which sections are optional to streamline the process.
Doctors of the World’s Safe Surgeries program offers training and resources to support inclusive practices, helping GP surgeries to reduce health inequalities and fulfil contract obligations. This is a community designed to promote inclusive registration and increase patient confidence. It is not an accreditation, and all practices should be a Safe Surgery in theory.
As an elected representative, your role is to advocate for residents and promote best practice amongst GP surgeries in your area.
Registration with a GP can be a huge benefit to vulnerable people and should be encouraged. For example, if you are in an area where there is asylum accommodation, find out what is being done to make those in such accommodation aware of their right to register with a GP, and facilitate the process.
You could ask local surgeries if they are signed up to the Safe Surgeries scheme. You will be able to find a list of surgeries in your ward online, and contact details may be available there or by request of the relevant team within your council.
Explore training and support in your area and share this where possible. For example, Healthy London Partnership provides training to reception staff, and there are plenty of other initiatives offering general staff support.
Patients must not be turned away from registering with a GP surgery due to not having the correct documentation. You can support residents to assert their rights if a practice does demand proof of identity or address. There are systemic barriers to staff implementing NHS guidelines correctly, and so it is not uncommon for patients to be prevented from registering on false grounds.
GP and nurse consultations in primary care as well as any treatment provided by a GP and other primary care services are free of charge to all, regardless of immigration status.
Record complaints about the registration practices of GP surgeries in your ward. Repeated incidents could suggest that a surgery is falling short of NHS England guidelines. There may be an element of soft gatekeeping to keep patient numbers down, or there may be a need for additional training.