Doctors of the World's Safe Surgeries initiative: supporting GP practices to improve access to primary care

Developing integrated and accessible services for inclusion health

Primary care is open to all, but often many people in inclusion health groups, including people without a fixed address, people seeking asylum and refugees, are wrongly refused access to the primary services they are entitled to. NHS England guidance on GP registration is clear: regardless of nationality or immigration status, everyone living in England can register and consult with a GP without charge. There is no regulatory requirement to prove identity or address in order to register and an NHS number is not required (1).

An investigation by the Bureau of Investigative Journalism in 2021 found that almost two thirds (63%) of GP practices surveyed in 10 locations across the UK would refuse to register someone without proof of address, proof of ID or legal immigration status. 14% of practices surveyed were unsure and only 24% of practices were willing to register the hypothetical patient without documents (2). Evidence from the Doctors of the World clinic also highlights similar issues of registration refusal for those who cannot provide proof of ID or address, despite NHS England guidance (3).

Doctors of the World's Safe Surgeries initiative was launched in 2018 and is a network of GP practices committed to tackling barriers preventing access to primary care and promoting the health of everyone in their community – regardless of their nationality or immigration status. Member practices receive free training for frontline staff, resources and access to a supportive national network to enhance the accessibility of their services and ensure that nobody in their community is turned away from primary care services. This includes guidance to support GP practices to adapt their registration policy and align with NHS England guidance (4), a toolkit for commissioners on promoting Safe Surgeries in their local area (5), posters for patient awareness (6) and resources for social prescribers (7).

Safe Surgeries aligns with other NHS initiatives, including CORE20Plus5 and the emphasis on identifying inclusion health groups locally to combat health inequalities, and is endorsed by Integrated Care Boards (ICBs) across the country. Implementing Safe Surgeries recommendations and inclusive registration processes also helps practices to demonstrate practice that is 'responsive' to the needs of their practice population during CQC inspections, by ensuring that anyone can access GP services.

A growing network of almost 1,500 practices across England have made commitment sas Safe Surgeries and are working towards making their services accessible for everyone in their communities. We will continue to work with primary care and ICBs across the country to expand the network and support frontline staff to welcome all patients, regardless of their circumstances.

Feedback from Safe Surgery member practices and primary care staff:

"It was important for us to become a Safe Surgery because we wanted to offer a safe place for the diverse populations in our community to access healthcare services without the worry of being asked for ID or proof of address. This was particularly important to us because of the large number of vulnerable patients living in our area and the need for them to feel safe and supported when visiting our practice. It is quick and easy to register patients, which had the added effect of reducing the reception and administration workload around registrations"

"We were delighted that Doctors of the World hosted a ‘Safe Surgeries’ session for our colleagues and partners recently. The training is unequivocally excellent,informative and enlightening and was a key component in our organisation becoming the first ‘System of Sanctuary’ in the country. A number of colleagues have advised that, since they did the training, they feel much more informed,in terms of supporting refugees and asylum seekers within their practices"

More information is available at https://www.doctorsoftheworld.org.uk/safesurgeries/

References
(1) Primary Medical Care Policy and Guidance Manual (PGM) https://www.england.nhs.uk/publication/primary-medical-care-policy-and-guidance-manual-pgm/

(2) Bureau of Investigative Journalism (2021) Most GP surgeries refuse to register undocumented migrants despite NHS policy https://www.thebureauinvestigates.com/stories/2021-07-15/most-gp-surgeries-refuse-to-register-undocumented-migrants
(3) Registration Refused: A study on access to GP registration in England (2018) https://www.doctorsoftheworld.org.uk/wp-content/uploads/2019/08/Registration-Refused-final.pdf

(4) Safe Surgeries toolkit https://www.doctorsoftheworld.org.uk/wp-content/uploads/2021/10/Safe-Surgeries-Toolkit-2021.pdf
(5) Toolkit for commissioners https://www.doctorsoftheworld.org.uk/wp-content/uploads/2019/05/CCG_safe_surgeries_toolkit_2019.pdf

(6) Poster for patient awareness https://www.doctorsoftheworld.org.uk/safesurgeries/safe-surgeries-toolkit/#:~:text=Posters%20for%20patient%20awareness

(7) Social prescribing resources https://www.doctorsoftheworld.org.uk/safesurgeries/safe-surgeries-toolkit/#:~:text=RESOURCES%20FOR%20FRONT%20LINE%20STAFF

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