Practices should know the rules regarding temporary residents, homeless patients, overseas visitors, the duty to give treatment, and when they can decline to register a patient.
Location:England
Audience:GPsPractice managers
Updated:
Thursday 27 January 2022
This guidance will clarify the conditions surrounding patient registration in GP practices in England.
The main principle is that anyone, regardless of nationality and residential status, may register and consult with a GP without charge.
Contract and regulatory conditions
You can read the full regulations which this guidance is based on in:
Practices have a contractual duty to provide emergency treatment and immediately necessary treatment free of charge for up to 14 days.
This applies to any person within their practice area:
who has been refused application for inclusion in the practice’s list of patients
who isn’t registered with another provider of essential services
whose application for acceptance as a temporary resident has been rejected.
Immediately necessary treatment in relation to people who are visiting England should be viewed as treatment of new and pre-existing conditions that have got worse during their stay. This is subject to the GP’s clinical judgement.
Declining a patient registration
Removing patients from your practice list
Both practices and patients have the right to end a patient-doctor relationship that isn't working. We outline the reasons and procedures for removing a patient from a GP list.
Practices have only a small degree of discretion under the contract about whether to register the patient.
Practices may only decline to register a patient (whether as a temporary resident or permanent patient) if they have reasonable grounds to do so. These grounds must not be related to their race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.
Registering without proof of identity or address
There is no contractual duty to seek evidence of identity, immigration status or proof of address. Practices should not refuse registration on the grounds that a patient is unable to produce such evidence.
Practice staff do not have to make any assessment of immigration status or eligibility for NHS care; they are not expected to act as immigration officials.
Homeless patients
People who are homeless have particular health needs and often suffer some of the worst outcomes. Both the BMA and NHS England are committed to ensuring homeless patients receive the same level of care as those with permanent addresses.
The same rules as above regarding identity and proof of address applies to homeless patients. Homeless patients are entitled to register with a GP using a temporary address, which may be a friend’s address or a day centre. The practice address may also be used to register them.
Anyone, regardless of their country of residence, is entitled to receive NHS primary medical services at a GP practice. This means tourists, or those from abroad visiting friends or family in England, should be treated in the same way as a UK resident. It also means GP practices cannot charge for this.
Practices must give patients a question form as part of the registration process (part of a GMS1, or own registration form). This allows patients to self-declare if they hold either a non-UK issued EHIC or an S1 (formerly E106).
Completing the form is not a requirement for registering the patient. The practice does not need to follow up with the patient if they don’t complete the form, and should register them as normal.
Practices must record any information provided in the patient’s medical record.
A non-UK EHIC must be sent by email to NHS Digital at [email protected].
An S1 healthcare certificate, or a copy of it, should go to the DWP overseas healthcare team at [email protected].
If the patient does not have their S1 form they can be registered in the normal way and there is no requirement for the practice to chase this up - the obligation is on the patient to ensure their form is registered.
Other considerations
If a GP practice receives very high volumes of returns, eg a university GP practice, then forms can be returned in batches (one attachment per patient).
The GMS1 form should only be used to register permanent patients - the GMS3 form for temporary patients.
You do not need to check a patient’s ID - practice staff are unlikely to be qualified to do this and should not attempt to interpret a patient’s immigration status.
The funding received will be the same as for any patient.
GPs should not make judgements as to the eligibility of patients to receive free secondary care without charge and should refer whenever clinically appropriate.
Patients with no immigration status
Immigration status makes no difference, any person in the UK is able to register with a GP practice and receive NHS primary medical services free of charge. Practice staff do not have to make any assessment of immigration status or eligibility for non-primary NHS care. You are not expected to act as immigration officials.
If you believe that someone is fraudulently trying to obtain treatment you should inform NHS England or your CCG.
Patients about to be released from the secure estate
GPs have a contractual obligation to accept a patient for pre-registration prior to their release from the secure residential estate. GP practices are asked to ensure that processes are in place to support this.
Plans are also progressing to enable patients to register with a GP in their place of detention in the same way as they register with a community GP. This will be rolled out next year across England.
