Version:	Review date:	Edited by:	Approved by:	Comments:
1	November 2024	Anne Jones	Anne Jones	New Policy

1 Introduction

1.1 Policy statement

Woodbrook Medical Centre will ensure there is equitable access for all patients who wish to register with the organisation and will follow the GP Patient Registration Standard Operating Principles for Primary Medical Care outlined in the NHS Primary Medical Care Policy and Guidance Manual (PGM) (v4).

The registration process must be followed diligently. As detailed in the PGM, a patient does not need to be ordinarily resident in the country to be eligible for NHS primary medical care. Therefore, anybody in England may register and consult with a GP without charge and without producing any form of identity.

As stipulated in the PGM, it is a contractual requirement that, once registered, all patients must be invited to participate in a new patient health check. However, neither registration nor clinical appointments should be delayed because of the unavailability of a new patient health check appointment.

1.2 Status

The organisation aims to design and implement policies and procedures that meet the diverse needs of our service and workforce, ensuring that none are placed at a disadvantage over others, in accordance with the Equality Act 2010. Consideration has been given to the impact this policy might have regarding the individual protected characteristics of those to whom it applies.

This document and any procedures contained within it are non-contractual and may be modified or withdrawn at any time. For the avoidance of doubt, it does not form part of your contract of employment. Furthermore, this document applies to all employees of the organisation and other individuals performing functions in relation to the organisation such as agency workers, locums, and contractors.

2 Patient registration

2.1 Registering the patient

Patients wishing to register with this organisation are to complete a GMS1 form or complete the online registration process which is detailed on the organisation’s website. Should the patient complete the online registration process, a supporting signed letter from the patient, posted or emailed to the organisation, is acceptable to complete the registration (i.e., patient signature).

Note, NHS Digital have developed Register with a GP surgery which enables this organisation to take patient registrations online quickly and easily. This standardises the online registration process throughout England.

2.2 Requesting documentary information from patients

Section 4.9.1 of the PGM explains that this organisation cannot refuse an application to join its list on the grounds of race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

Additionally, there is no regulatory requirement to provide identity, address, immigration status or the provision of an NHS number to register with the organisation. However, there are practical reasons why this organisation might need to be assured that people are who they say they are, or to check where they live. Seeing some form of ID will help to ensure the correct matching of a patient to the NHS central patient registry, thereby ensuring any previous medical notes are transferred.

Should this organisation request documentation to verify a patient’s identity or immigration status, then the organisation must ensure the same process is applied to all patients requesting registration. This organisation must not expect a patient to present a photograph as this could be discriminatory.

It must be acknowledged that while most patients will not find it difficult to produce ID, there will be some patients who live in the practice area but are legitimately unable to produce any documentation. Examples are detailed within the PGM at section 4.9.6.

2.3 Declining applications

The organisation is permitted to decline a patient’s application to join the practice if:

The commissioner agrees that the organisation list may be closed to new patients

There are reasonable grounds to do so, e.g., the patient has previously been removed from the organisation list

Any refusals will be confirmed in writing to the patient, with the reasons fully stated, within 14 days of the refusal. The date and reason for refusal will be recorded along with the name of the patient and this information will be made available to commissioners if requested.

2.4 Practice areas

The PGM explains that all organisations are required to have agreed an inner boundary with their commissioner. Anyone residing within this area is entitled to apply to register for primary medical services and the organisation boundary must be clearly advertised to patients on the organisation’s information leaflet and/or website.

The organisation has also agreed an outer boundary. Patients who move from the inner boundary area but still reside in the outer boundary area may be able to remain registered with the organisation should they so wish and the organisation agrees.

The PGM further advises that this organisation may register new patients who live outside the organisation area, without any obligation to provide home visits or services out of hours. It is for the organisation to decide, at the point of registration, whether it is clinically appropriate and practical to register the individual patient in that way.

2.5 Registering for online services

It should be noted that while there is no requirement for ID when initially registering at this organisation, this should not be confused with those patients who wish to have access to online services.

2.6 Registering children

The same registration process should be followed when registering children (0 – 18 years of age). However, there are certain circumstances that this organisation should be aware of in relation to safeguarding guidance.

As detailed in the PGM, if a child under the age of 16 attempts to register alone, or with an adult who does not have parental responsibility, the safeguarding lead should be alerted.

It is recommended that the organisation gains assurance by:

Obtaining proof of identify for each child (i.e., birth certificate)

Ensuring that an adult with parental responsibility is present at registration (and that the adult can prove they have parental responsibility)

Offering the child a new patient health check

Obtaining supporting documentation from official sources, e.g., previous GP, social workers, etc.

When doubt exists, the organisation’s safeguarding lead is to be informed and appropriate actions taken.

2.7 Registration of those previously registered with Defence Medical Services

When service personnel leave the armed forces, they become veterans and their primary healthcare reverts to the responsibility of the local NHS. Veterans will be provided with copies of their medical records which they will give to their new practice during registration.

Armed Forces veterans are entitled to priority treatment if their injury or condition came about because of their service (subject to clinical need). This is regardless of whether they receive a war pension. Further guidance can be found here and within the Priority treatment for veterans document. Prior service should be recorded on registration and allocated the correct SNOMED code:

Military veteran SCTID: 753651000000107. Having this code will enable access to specialist care or charity support as necessary for the patient.

2.8 Registration of civil servants, their dependants and the dependants of members of the Armed Forces returning from overseas service

Comprehensive guidance regarding the registration of civil servants posted overseas, their relevant family members who accompanied them on their posting and relevant family members who have accompanied a member of the Armed Forces posted overseas is detailed within the PGM at section 4.15. This includes enabling such individuals to register as a permanent or temporary patient in advance of or upon their return to the UK.

2.9 Registering Commonwealth, Gurkha or Nepali veterans

NHS England advises the following veterans are not entitled to receive free healthcare from the NHS after their discharge date from the UK Armed Forces:

A citizen of a member of the Commonwealth
A Gurkha citizen
A Nepali citizen

In order to receive free healthcare through the NHS after this date, these groups must gain indefinite leave by using the immigration rules and process.

2.10 Registering asylum seekers, refugees and other migrants

As detailed in CQC GP Mythbuster 36: Registration and treatment of asylum seekers, refugees and other migrants, this organisation has a contractual duty to provide emergency and immediately necessary treatment free of charge for everyone.

This includes groups of patients whose circumstances may make them vulnerable such as asylum seekers, refugees and other vulnerable migrants. It should be noted that the CQC will inspect the organisation to ensure that the fundamental standards relating to patient equality are being upheld within both:

Regulation 10 – treating people with dignity and respect
Regulation 13 – protecting people from abuse and improper treatment

Additional guidance is available from NHS England on how to improve access for specific groups and how to register with a GP surgery.

PCSE provides guidance on patient registration and re-registration, including advice on how to register a refugee from Afghanistan. Furthermore, Public Health England has published the online migrant health guide which covers entitlement and other health issues.

2.11 Registering a homeless patient

This organisation will adhere to the guidance outlined in CQC GP Mythbuster 29: Looking after homeless patients in General Practice and allow any homeless patient to register by using either a temporary address such as a friend’s address or a day centre. Furthermore, this vulnerable group can also use the practice address to register as a method of contact is required, for example, should they need to be advised of a secondary care appointment or test results.

This organisation will consider the homeless community and has established the following:

Provision of double appointments
Reducing prescriptions to as short a duration as possible
Promoting clear boundaries for consultations
Providing fast access to a named GP
Waiving normal charges for housing letters or medical reports

2.12 Duty to refer a homeless patient

The Homelessness Reduction Act (2017) places renewed emphasis on homelessness prevention and Section 10 requires public authorities in England to notify a local housing authority (LHA) of service users who they think may be homeless or at risk of becoming homeless.

While it is not mandatory for any GP practice to have any duty to refer to a LHA for further support, it would be beneficial to do so.

Any referrals to a LHA must include:

The service user’s name
Any contact details
An agreed reason for referring the user

It should be noted that organisations can refer without consent to safeguard children and vulnerable adults.

For further advice, refer to the governmental guidance titled A guide to the duty to refer. Additionally, further resources for healthcare professionals on homelessness can be found within GP Mythbuster 29.

2.13 Registering under the Mental Capacity Act

The Mental Capacity Act 2005 is designed to protect and empower people aged over 16 who are unable to make decisions about their care and treatment.

If a person is unable to register with a GP because they cannot make decisions about their care, registration can be done by:

A relative
The main carer
A lasting power of attorney
A person appointed by a court under the Mental Capacity Act

Further reading can be sought from the NHS document titled Mental Capacity Act and the Mental Capacity Act Policy.

2.14 Rights to treatment and services

People who are not ‘ordinarily resident’ may be charged for some NHS services and the NHS (Charges to Overseas Visitors) Regulations 2015 apply to all courses of treatment commenced on or after 6 April 2015.

As detailed in the PGM at 4.4.5, this organisation is required to provide all new patients with a revised GMS1 form which includes supplementary questions to determine a patient’s eligibility for healthcare.

For those patients who self-declare that they hold either a non-UK issued EHIC or a S1 form, the organisation is required to manually record that the patient holds either a non-UK issued EHIC or S1 form in the patient’s medical record and then email the form and supplementary questions to NHS Digital (for non-UK issued EHIC cards) or the Overseas Healthcare Team (for S1 forms). Non-UK EHIC: nhsdigital.costrecovery@nhs.net and S1 forms OHT.overseasvisitorsteam@dwp.gsi.gov.uk

Further information can be sought from the following Gov.uk documents:

This organisation will refer overseas visitors when a referral is clinically appropriate.

If it is considered that a charge will apply for treatment following a referral, the referral should still be made to enable the secondary care clinical teams to decide if treatment is urgent and therefore should be provided in advance of payment.

This organisation will ensure that patients are made aware that they may be charged for treatment for which they are to be referred by using the Overseas NHS visitors: implementing the charging regulations.

2.15 Temporary residents

The PGM explains that patients should be offered the option of registering as a temporary resident if they are resident in the practice area for more than 24 hours but less than three months.

In some cases, a prospective patient may not know how long they will reside in an area, for example, destitute asylum seekers housed in temporary Home Office commissioned “initial” accommodation. Generally, in such cases when there is uncertainty over the length of time that a patient may be residing in an area but this is likely to be months rather than weeks, NHS England advises that the patient should be registered as a permanent patient.

Further information regarding temporary residents can be found in the useful NHS patient document titled How do I register as a temporary resident with a GP?

2.16 Immediately necessary treatment

As detailed in the PGM, this organisation is under a duty to provide emergency or immediately necessary treatment, when clinically necessary, irrespective of nationality or immigration status. The organisation is to provide 14 days of further cover following the provision of immediate and necessary treatment.

2.17 Registering patients released from prisons, immigration centres or children’s secure facilities

Patients who do not have a registered GP or who are being released to this area, have the ability to register with this organisation prior to leaving the detained estate. This agreement includes the transfer of clinical information, including medication history and substance misuse management plans to this organisation, to enable the appropriate level of care to be delivered when the patient first presents at this organisation.

3 New patient health check

3.1 Overview

It is a contractual requirement that this organisation invites newly registered patients to participate in a new patient health check. The purpose of this is to discuss any existing conditions with the patient while also taking the opportunity to review the patient’s lifestyle and make recommendations through evidence-based advice to improve the lifestyle of the patient.

3.2 Patient invitation

Patients will be invited to attend a new patient health check when they register with the organisation. Ideally, this appointment will be arranged for a date within one month of the patient registering at the organisation.

Patients are to be advised that they can be seen by a GP or nurse prior to this check but will still need to attend the original appointment for the check as planned. All staff are to ensure that they accurately record invitations and use the appropriate SNOMED/read code for a new patient health check in each patient’s healthcare record.

4 The NHS Health Check

4.1 Overview

The NHS Health Check best practice guidance document explains that the NHS Health Check is a prevention programme that aims to reduce the chance of a heart attack, stroke or developing some forms of dementia in people aged 40-74. It achieves this by assessing the top seven risk factors driving the burden of non-communicable disease in England, and by providing individuals with behavioural support and, where appropriate, pharmacological treatment. All eligible patients are to be offered an NHS Health Check once every five years.

Full guidance on eligibility, tests, risk assessments, clinical risk management and communication, including marketing and branding for the checks can be found in the hyperlinked guidance document. Health questionnaire templates can be found at Annex A for adults and Annex B for children.

4.2 Increasing uptake of the NHS Health Checks

Ideas for increasing the uptake of NHS Health Checks are to be found in Public Health England’s Top tips for increasing the uptake of NHS Health Checks.

There is also a useful guide regarding low-cost ways to increase NHS Health Check attendance as a result of a randomised trial which personalises the invitation letter and the use of text messages to support it. The template for the National NHS Health Check invitation letter can be found here.

Should a patient not respond, a follow-up letter is to be sent one week later. Again, this is to be recorded in the individual’s healthcare record and the appropriate SNOMED/read code used. Patients are to receive three recall letters and, should they fail to respond, this should be recorded within the patient’s healthcare record and SNOMED/read coded accordingly.

Staff may invite patients for the NHS Health Check via telephone or text (if applicable). All invitations are to be recorded in the patient’s healthcare record and coded with the appropriate SNOMED/read code.

4.3 Additional resources

Further resources such as appointment cards, flyers and templates can be found here.

Please refer to the Health Questionnaire form here

New Patient Registration and Health Check Polic