Homelessness and Healthcare: the right to register

Friday, 6 October 2017 - 3:13pm

The London Homeless Health Programme and Groundswell have been working to improve access to all doctors' surgeries for people who are homeless in London. 

Left to right: Darren Murinas, CEO of Expert Citizens CIC, Simmy Akhtar, CEO of Healthwatch Stoke-on-Trent & Andy Meakin, Director of VOICES

If you have any problems registering with a GP due to a lack of address or identification, there are steps you can take.

In Spring 2016, the Healthy London Partnership’s London Homeless Health Programme asked Groundswell to research the experiences of people who are homeless in London using NHS services and published the More than a statistic report based on their findings.

Two of Groundswell’s Peer Researchers, who have been homeless themselves, interviewed people using hostels and day centres about a range of health services. One of the findings that really stood out was how difficult people who sleep rough and people in insecure accommodation find it to register and use a GP surgery. As one participant explained:

“When you try to register with a doctor and they send you away because you are homeless you just end up stuck… Some of us have got mental health problems, some physical health problems and a lot of the time it might be those problems that have landed us in homelessness to begin with. When these problems aren’t going to get looked at because you don’t have an address then we are just going to be in a vicious cycle.”

It was all too common for people to report that they had been refused access to a GP practice due to not having ID, having no fixed address or not being able to prove their immigration status. This was despite the fact that it’s against NHS patient registration guidelines, which state:

“People do not need a fixed address or identification to register or access treatment at GP practices”

Being homeless can have a hugely damaging effect on people’s physical and mental health, and homeless people often experience complex health issues. We need to make sure that people can get the treatment they need at a GP surgery. Not being able to use a GP means that people turn to A&E Departments, often when the issue has become far worse. Making effective use of primary care is not only good for people’s health – it also saves money for the NHS.

With the Healthy London Partnership and Healthwatch, Groundswell have delivered over 40,000 ‘My Right to Healthcare’ cards to shelters, day centres, food banks and other organisations across London to spread the word that being denied access to a GP is not acceptable. 

The cards can be used by people who are homeless to remind staff at GP practices of the NHS England registration guidelines. These state that to register and receive treatment at a GP practice:

  • You do not need a fixed address
  • You do not need identification
  • Your immigration status does not matter.

These are the NHS rules. However, there are some practical reasons why GP practices can ask all patients for ID. One example is to make sure that the practice is able to get the correct records from your last doctor’s practice. So you may be asked for some ID, but the practice cannot say no to registering you if you don’t have ID documents.

The cards include Healthwatch’s national helpline number in case people continue to have problems.

The cards were co-designed with Groundswell Health Peer Advocates who have been homeless themselves and now support people to address their health needs. They are business card sized so that they can be printed cheaply by a local print shop. The print files are on the Groundswell website so that people can print them off themselves.

Our evaluation has shown that the cards are supporting people to get registered with a GP across London, and we hope that our work will have a broader impact across the UK.

Since the cards were first published, the London Homeless Health Programme jointly with Pathway has developed an e-learning module for GP practice managers and receptionists to improve the care and experience of people who are experiencing homelessness in London.

NHS England have also recently produced a leaflet that people who are homeless can use when they need to register with a GP.

Access to GPs – learning from Stoke

Andy Meakin, Director, VOICES

VOICES began in October 2014, working with people experiencing combinations of homelessness, mental ill-health, addiction, and histories of offending. We aim to engage with people that are not accessing the services they need.

Early in our frontline delivery, staff reported difficulties in supporting people to register with a GP. The support of a GP can often make a big difference to the accessibility of other needed services: support for mental and physical health, clinical interventions for drug and alcohol misuse, and provide evidence of medical circumstances to help people access their housing or benefits entitlements.

We approached Healthwatch Stoke-on-Trent and Expert Citizens, and together devised a mystery shopping exercise. Expert Citizens telephoned 47 practices across Stoke-on-Trent posing as support workers wanting to register a homeless person without ID. Only a quarter of these agreed to register in the circumstances described. Half the practices refused. The remainder could not give a clear answer.

Our report’s findings chimed with the experience of services working with homeless people elsewhere in the country. We came across the work of the London Homeless Health Programme, Pathway, and Groundswell, and the idea of setting out people’s rights to register in a credit card sized format. These cards are aimed at helping people to self-advocate when approaching GPs, and are also useful for support workers, friends, or relatives working as advocates.

We created our own version of the cards and circulated thousands of copies to organisations working with people that are homeless across Stoke-on-Trent. This included every GP practice in the city. Our covering letter set out the story of the work, as well as our summary of the NHS England guidance for reference.

Our work has generated a great deal of interest and raised the profile of health inequalities for people experiencing homelessness. We’re grateful for the inspiration of the London Homeless Health Programme, Pathway, and Groundswell.

We believe that this work is replicable across the country and encourage people to use what we have produced. Please feel free to adapt and use our materials in your area – getting the cards printed up is relatively cheap.  We’re keen to learn how you get on. You can find our ‘I have a right to register’ materials here.

Next year we intend to repeat the mystery shopping exercise to test the effectiveness of our efforts. To find out more, you can contact us via enquiries@voicesofstoke.org.uk or @voicesofstoke on Twitter.

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Andy Meakin

Andy Meakin

Project Director of VOICES

Andy is a twice graduate of Keele University with a professional background in Local Authority commissioning and contract management. His experience includes supported housing, social care, adult education and employment programmes.

Twitter: @voicesofstoke