Hackney GPs ‘denying access to patients’ by insisting on proof of ID, local health watchdog finds

Hackney GPs have received a stern warning after a local health watchdog found that a majority of the borough’s practices have been denying patients access to healthcare if they do not produce proof of address or ID when registering.

Prospective patients are not required to prove their identity, address, immigration status, or provide an NHS number in order to register with a GP practice, according to the Primary Care Policy and Governance Manual.

However, when Healthwatch Hackney called round every one of Hackney’s 39 practices over a fortnight in March and asked staff to explain how to register, 59 per cent of practices insisted on proof of identity, with 69 per cent needing a proof of address.  

Healthwatch said: “One of the key NHS principles is equality of access to NHS services, with access not to be refused on unreasonable grounds. Healthwatch Hackney has, however, become aware that many GP practices are requiring patients to present ID and proof of address. 

“This is a serious obstacle that is preventing some Hackney residents from accessing primary health care services. The importance of GP registration has been highlighted by the Covid-19 pandemic and the need to ensure all eligible residents have the opportunity to be vaccinated. 

“Registration is also vital to ensure early access to diagnosis and treatment before health problems become severe, and appropriate use of primary health care rather than emergency services.”

According to the local health watchdog, many practices have continued to put up the barriers of proof of ID and address preventing some from registering, despite a reminder from City & Hackney clinical commissioning group (CCG) in November 2019 of the importance of patient registration without passports or proof of address.

Healthwatch went on to warn that such barriers particularly impact the vulnerable, including homeless people, migrants, asylum seekers and people with learning disabilities.

The charity outlined the reasons a resident might not be able to comply with a practice’s request, including the £85 cost of a passport or a passport being held by the Home Office.

It cited the Windrush scandal as an example of how requiring a passport can deny care to citizens, and pointed to national statistics showing that 53 per cent of Black people have a driving licence.

During the course of Healthwatch’s research, one practice said that proof of ID was being asked for due to a number of ‘fraudulent’ applications to join up.

Some practices in Hackney go so far as to be particularly specific on what would be accepted as proof of address and ask for two forms, including tenancy agreements, council tax bills, an original bank statement, or a bill from the last three months. 

All surgeries have now received a firm letter, seen by the Citizen, from North East London CCG primary care programme director Richard Bull, who confirms that some practices in Hackney “are denying patients access to healthcare by insisting that new registrants produce certain documents”.

Bull restates the guidance that patients should not be being asked for proof of registration status or address, as well as to register patients in full unless it is clear only a temporary registration is required.

The letter adds: “Please do ensure that any of your staff involved in registering patients are aware of what is and what is not required. There is often a disconnect between what management believes is happening and what actually happens at the front line.”

The report also highlights other difficulties in access, with six surgeries needing multiple calls from Healthwatch to get connected, and some leaning heavily on online services.

One practice suggested they would only accept paper registration as a last resort, with the report noting that the receptionist stated firmly that the patient should go to an internet café or library to complete the registration form.

Responding to the report, Cllr Chris Kennedy said: “I am disappointed that so many of our GP practices are going against the clear NHS instruction that proof of ID is not needed to register with your local practice. 

“However, I am pleased that the NEL CCG has rebuffed the critics who predicted that it would be remote and disconnected from the people by standing firmly on their side and clearly stating that you do not need proof of ID to register with your local doctors’ surgery.”

City & Hackney GP Federation declined to comment.

Healthwatch have now recommended that the CCG urgently request NHS Digital change the process practices use to verify registration so doctors do not get penalised for discrepancies in patient details.

It also suggests that a standard registration form is adopted across the borough “that is sensitive to the inability of some residents to provide proof of identity and/or address”.

The watchdog also called for staff to be taught that proof of address and identity must not be required of patients.

A CCG spokesperson said: “NEL CCG have communicated with all GP practices that it is unnecessary to require proof of ID from patients in order to register.

“We take the findings of the Healthwatch report seriously and remain committed to ensuring equal access to registering with GP practices for our residents and patients.

“Healthwatch have agreed to do this survey again in six months’ time in City and Hackney and we hope to see a much improved outcome in the findings.”