DOCTORS AND CAMPAINGNERS claim that refusing GP registration to those with no fixed address should be treated as a ‘never event’ in a new editorial in the British Journal of General Practice.
So tells the National Bargee Travellers Association.
It adding—People who are unlawfully refused registration with a GP should be protected by the same kind of patient-safety response used for other serious, preventable healthcare failures, according to a new editorial published in the British Journal of General Practice (BJGP).
The editorial—written by practicing GP’s and researchers at Health Equity Evidence Centre at Queen Mary University of London—argues that the unlawful refusal of GP registration is a widespread and preventable barrier to healthcare access, disproportionately affecting some of the most vulnerable groups in society, including people experiencing homelessness, people seeking asylum, victims of human trafficking and nomadic communities.
NHS policy states that people living in England are entitled to register with a local GP practice and that they should not be refused registration because they do not have a permanent address or identification documents. Yet research and investigations have repeatedly found practices refusing to register eligible patients on these grounds. One investigation by the charity Friends, Families & Travellers found that 65% of GP practices contacted across two mystery-shopping exercises refused to register a theoretical patient who did not have an address or ID.
The BJGP editorial argues that these failures meet the criteria traditionally used to define a 'never event': a serious incident that is preventable because national guidance and safeguards exist which should prevent it from happening. Other such ‘never events’ could include wrong-site surgery, retained foreign objects post-procedure or mis-administered medication routes. The editorial states that applying this framework to unlawful GP registration refusals would create stronger incentives for practices to comply with existing NHS policy and would provide a mechanism for investigating repeated failures.
A Right to Healthcare Should Mean a Right to Register.
Valentina D'Orazio, Senior Policy Manager at Doctors of the World, recognises the harm that being denied a GP can cause:
Fundamental human right
“Access to healthcare is a fundamental human right, yet far too many people in the UK continue to face barriers that prevent them from getting the care they need. Health exclusion harms individuals, leads to poorer health outcomes, deepens existing inequalities and greater pressure on services. Everyone should be able to access healthcare safely and with dignity, regardless of their background or circumstances.”
Dr Fred Barker— the editorial’s lead author—echoes these sentiments:
“If healthcare access is a human right, then refusing patients healthcare access is a human rights breach. These events should therefore be taken far more seriously in the NHS; classifying unlawful GP registration refusals as 'never events' would be a much-needed step in the right direction.”
The BJGP editorial says that simply issuing further guidance is unlikely to be sufficient. Evidence from previous interventions suggests that registration barriers can persist even after practices have been provided with information about the rules. A separate mystery-shopping exercise in Waltham Forest found that proof of address was required by 73% of practices. Following local interventions, such as borough wide training for GP staff to clarify that an address was not required to register, this figure subsequently rose to 87%.
The BJGP is therefore calling for a removal of any potentially ambiguous wording in the guidelines as well as refusals to be investigated through the existing patient-safety framework. Currently the guidance states that patients without documents showing an address should not be refused, but it also suggests that personal documentation is important during the registration process.
Refusals should be individually investigated under the 'Patient Safety Incident Response Framework' with oversight by the Care Quality Commission (CQC). The BJGP believes that removing this ambiguity, alongside a stronger accountability mechanism, would help ensure that people are able to access the general practice to which they are legally entitled.
The experience of Itinerant boaters
Two of the editorial’s authors—Fred Barker and Joy Anderson—are both itinerant boaters, and have personally witnessed discrimination affecting themselves and members of their community. For people who live on boats, the absence of a conventional residential address can become a significant barrier when attempting to register with a GP, despite NHS rules making clear that a permanent home address is not a requirement for registration.
Layla Redway—an itinerant boater—has experienced difficulty accessing healthcare as her home lacks a fixed address:
“I have multiple health conditions and have been put at serious risk by the health system on more than one occasion due to living nowhere near the address on my driving licence. I was denied a smear test on the grounds that they don’t do routine procedures for ‘temporary’ patients and I’ve had regular issues getting my prescribed medication.”
Alain Gough-Olaya—an older adults community mental health nurse who lives itinerantly on a boat—recognises these difficulties in his private and professional life:
“Every day at work I see the importance of being registered with a GP from the primary care that they provide, to accessing secondary health services, and then the coordination of all of these services. And yet I also struggled to initially register with a GP. Now I currently live and work over 100 miles away from my GP, yet I am reluctant to change to a closer GP due to the difficulties I faced in registering initially.”
A kinder and more equitable NHS
The BJGP editorial acknowledges that introducing a never-event framework could create additional administrative work for practices. However, it argues that this burden would primarily fall on practices that continue to unlawfully refuse registration, and that the approach would provide a constructive way of improving access while allowing practices autonomy over how they implement the necessary changes.
Ian McDowell—the National Secretary of the National Bargee Travellers Association (NBTA), an organisation that campaigns for and supports itinerant boat dwellers—stated:
“Not having a permanent address should not be a reason to refuse to register a person. In the past, someone who was refused by a GP could go to NHS England and NHS England would tell the GP to register the boater, and the GP would comply. After the change in 2022, there seems to be no way to make GPs follow the national policy to allow people without addresses to register, instead creating a seemingly endless loop of whose job it is to enforce. Something needs to change. People who live and work in Britain, whoever they are, shouldn't be refused a GP.
The BJGP editorial describes unlawful denial of GP registration as a common example of systemic discrimination against vulnerable patient groups and argues that the problem requires urgent action. They conclude that treating these incidents as never events would both encourage practices to act and provide a mechanism for holding those that fail to provide equitable access to account.