Today, Friends, Families and Travellers (FFT) release the results of a mystery shopping exercise which found 74 out of 100 GP surgeries broke NHS England guidance by refusing to register a nomadic patient in March and April of this year. A further 17 GP surgeries did not answer the phone despite receiving phone calls on three different dates and times from our mystery shopper. This means that inequalities in registration for people living nomadically has significantly worsened since our last report in 2019.
The most common reasons for refused registration from the 74 GP practices were because the mystery shopper was unable to provide proof of identity, proof of fixed address or register online. All 74 GP practices who refused registrations on these grounds failed to comply with NHS England guidelines, as well as anti-discrimination legislation in the Equality Act.
The first guiding principle of the NHS is that it provides a comprehensive service, available to all and NHS guidelines say, “When applying to become a patient there is no regulatory requirement to prove identity, address, immigration status or the provision of an NHS number in order to register” and “Delivery of applications for patient registration may be by any means, including post and digital”
Despite clear NHS England guidelines, the recent mystery shop exercise found that an overwhelming number of GP practices are using policies that unfairly disadvantage Romany, Traveller and Boater communities. Romany and Traveller communities are known to face some of the most severe health inequalities and poor life outcomes amongst the United Kingdom population, even when compared with other ethnic minorities and other groups experiencing exclusion.
For patients experiencing multiple disadvantage, with no address, no identification and low or no literacy leading to digital exclusion, only 6 of the 100 GP surgeries would have allowed them to register.
Friends, Families and Travellers research conducted in 2019 found that 24 of 50 GP practices contacted wrongfully refused to register a Romany or Traveller person. Today’s research is a concerning sign that inequalities in healthcare access have worsened since 2019 and during the COVID-19 pandemic.
Friends, Families and Travellers are calling on the newly appointed Secretary of State for Health and Social Care, Sajid Javid, to make a clear commitment to ensure that patients who choose registration through non-digital means should be able to access all NHS healthcare settings.
The report also calls for NHS England and NHS Improvement to develop a national and local accountability framework for GP registrations, as well as to introduce contractual obligations for GP practices to register patients who choose this through non-digital means, unless there are good clinical reasons to the contrary.
Mattey Mitchell, Health Campaigns Officer at Friends, Families and Travellers said:
Access to healthcare for Romany and Traveller people has plummeted at a time when these communities need it most. NHS Guidance is very clear on this – we must take pains to protect the most marginalised in our society from the effects of the pandemic. We have seen great efforts on that front, and yet Romany and Traveller communities appear once again to have fallen through the cracks. It’s imperative that we address these inequalities and, more importantly, that we reflect critically on what this says about our collective values – is it permissible for any group in modern Britain to experience this level of exclusion?
Sarah Sweeney, Policy and Communications Manager at Friends, Families and Travellers said:
“Our health system is one of the safest in the world, so it is unacceptable and unjust that the NHS is failing people in need of healthcare on such a simple measure. It is essential that the Secretary of State urgently works to address this longstanding accountability vacuum so that people are no longer locked out of GP surgeries. We will be scaling up our work mystery shopping GPs across England over the coming months and will be in contact with GPs, Clinical Commissioning Groups and the Care Quality Commission wherever we find wrongful refused registrations. The NHS should be open to all.”
Lydia, a Liveaboard Boater explained:
“My partner and I are Liveaboard Boaters, when I became pregnant, my husband tried to register with a GP, to see how achievable it would be for me – but without me having to deal with the stress. We cruised across 3 or so cities, trying to register with 5 or more GPs. No one would take my husband without evidence of a fixed address. We ended up moving to a location near my parents so I could use my childhood GP surgery with my parents address. Not being able to register adds to stress, when you’re in a position that you don’t want more stress. When we moved away from London, my partner had to commute into work which meant we were spending additional money on travel during this time. We would have preferred to stay local if it had been possible, but I needed continuity of care throughout the pregnancy. We had access to solutions, like having a car and my parent’s address, but many people won’t have these options.”
Beccy, in Bristol, who lives in her van full time said:
“About three years ago, I had been registered with a GP surgery who had given me permission to register and use the address of the surgery as my postal address and to receive my medical post there – they were really helpful. I later moved to a different area and tried to register with the surgery there. The surgery refused to register me without evidence of a fixed address. I offered to use my parents address in another area and they said it had to be a local address – the receptionist said that the system wouldn’t let her register me otherwise, but the systems can’t be that different in the same area. At the time I didn’t know anyone in the area, so I had to ask someone I didn’t know that well to give me permission to use their address. At that point the homeowner gave me a letter to confirm they gave me permission and I’m now having to rely on individuals associated with them to provide me with my medical mail.”
Domino, from the Boater community, said:
“Since 2019 I have lived nomadically in several ways and also been homeless; in that time I have tried to register with GP surgeries across Bristol and London. I have invariably been refused registration due to having no fixed abode, despite providing the NHS policies which identify this as illegal. I was left without any support for about 2 years – it’s only been in the last two months after getting a registered address that I’ve been able to access GP healthcare – meanwhile both my physical and mental health were made worse for not receiving any primary care. I have probably tried to register with over 20 surgeries. In some cases, people have been openly hostile to me for challenging their assertion that they are entitled to refuse care to people with no fixed abode – we’re meant to have universal healthcare in the UK, the whole situation is unnecessarily problematic and discriminatory for people who don’t have a fixed address. There is often limited compassion and flexibility in the active refusal to comply with the duty of care; it gets really demoralising to hear that you can’t register from GPs four or five times in a row when you’re finding it hard enough to get out of bed anyway, and you need emergency medication. It ends up putting increased strain on the NHS, A&E and 111 services when they become the only form of healthcare available to you – it’s all completely avoidable.”
About Friends, Families and Travellers (FFT)
Friends, Families and Travellers is a leading national charity that works on behalf of all Gypsies, Roma and Travellers regardless of ethnicity, culture or background.
Tel: 07425 419853 Email: firstname.lastname@example.org
Locked out: A snapshot of access to General Practice for nomadic communities during the COVID-19 pandemic. July 2021. View here.
No room at the inn: How easy is it for nomadic Gypsies and Travellers to access primary care? March 2019. View here.