The BMJ Christmas appeal 2018: a new clinic for the UK’s most vulnerable patientsBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5165 (Published 13 December 2018) Cite this as: BMJ 2018;363:k5165
All rapid responses
‘We only accept patients with photographic proof of ID’
‘Only people with valid visas can register at this practice’
‘We have no reciprocal agreement with that country, so we can’t register you’
Which of these statements are true? None, although at Doctors of the World London clinic we hear all of them. The NHS Primary Care Policy and Guidance Manual states, “A patient does not need to be “ordinarily resident” in the country to be eligible for NHS primary medical care – this only applies to secondary (hospital) care. In effect, therefore, anybody in England may register and consult with a GP without charge.”1
However studies have found that many vulnerable people including pregnant women, trafficked persons, homeless people, asylum seekers and undocumented migrants are denied primary care2,3. Some practices maintain registration policies that don’t allow for people who have no proof of address or ID. This can bar access to preventative healthcare including chronic disease treatment, cancer screening and vaccination, which the NHS will only pay for later, and at worst leaves people living in fear with untreated chronic diseases, no antenatal care, untreated psychiatric illness and delayed cancer diagnoses.
In the Equality and Human Rights Commission report, “Making sure people seeking and refused asylum can access healthcare: what needs to change?”4 this barrier to healthcare in the UK is highlighted as a human rights issue. As a signatory of the International Covenant on Economic, Social and Cultural Rights, the UK should “recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”. This includes people seeking asylum, who are particularly at risk. Formed of a literature review and qualitative study, their recommendations include ‘Put mechanisms in place to monitor and address any barriers to accessing healthcare services experienced by people who are or have been in the asylum process, such as instances of incorrect refusal of GP registration.’4
May this report be a call to action to assess our registration policies and ensure we are not excluding the most vulnerable in our society from vital primary care.
Dr Katherine Taylor
London GP and Health Advisor at Doctors of the World, UK
1. NHS England (2017), ‘Primary medical care policy and guidance manual’. [accessed: 30 November 2018]. https://www.england.nhs.uk/publication/primary-medical-care-policy-and-g...
2. Doctors of the World UK (2017), 'Registration refused: A study on access to GP registration in England Update 2017' [accessed: 30 November 2018]. https://www.doctorsoftheworld.org.uk/wp-content/uploads/import-from-old-...
3. Rafighi, E., Poduval, S., Legido-Quigley, H. and Howard, N. (2016), ‘National Health Service principles as experienced by vulnerable London migrants in “Austerity Britain”: a qualitative study of rights, entitlements, and civil-society advocacy’, International Journal of Health Policy and Management, vol. 5, no. 10, pp. 589–97. doi: 10.15171/ijhpm.2016.50.
4. Equality and Human Rights Commission (2018), Making sure people seeking and refused asylum can access healthcare: what needs to change? Available at: https://www.equalityhumanrights.com/en/refugees-asylum-and-immigration.
Competing interests: Volunteer GP at Doctors of the World Clinic and employed part-time as health advisor at Doctors of the World