Registration without documentation: an exploration of the experiences of General Practice staff registering new patients unable to provide documentation in North East London.

Problem

NHS England guidance states that not being able to provide proof of address or identification for GP registration cannot be used as a reason to refuse registration. Despite this, research has found that patients who are unable to produce the documentation requested, are refused registration by some practices. In response to this groups such as Pathway, Groundswell and Doctors of the World have been working to support patients to register and provide training to GP staff. However, GP practice staff's experience of new patient registration processes has never been explored. This on-going qualitative study aims to better understand the process by which registration is refused and factors that operate to influence this. It explores how non-clinical GP staff experience of and current practice regarding patient registration, perceptions of patients without documentation and obstacles to their registration. Also explored is participants’ ideas of how to improve access for this group of patients; aiming to produce recommendations that are sustainable and acceptable.

Approach

Thirty-three participants across three boroughs in North East London have taken part in focus group discussions or individual interviews. A initial thematic analysis, utilising Pierre Bourdieu’s theory of power and practice has been undertaken and will be subject to participant checking before the analysis is completed.

Findings

Key emerging themes that engender reluctance to register patients without documentation include: perceived lack of clarity of national guidance, perception that this patient group represent increased financial, clinical and administrative burden on the practice, concerns regarding patient & staff safety and illegal activity, concerns regarding specific legal or statutory requirements and duties and a sense of ‘moral’ responsibility to other patients and the wider NHS regarding resource distribution.

Consequences

Much current work around improving the inclusivity of registration focuses on ensuring staff are aware of guidance, but this study reveals a picture not just of a lack of knowledge of guidance, but a complex set of factors that work to make staff reluctant to register patients without documents. Specific issues that need to be addressed in on-going advocacy and education initiatives, as well as by policy makers, include: a perceived lack of clarity of NHS England’s registration guidance, perceived increased administrative and financial pressure specific to GP practice relating to the registration of certain patient groups, and unanswered questions about the responsibility of individual non-clinical staff regarding new patients. Beyond providing ideas of how to address challenges for registration for patients without documents, further analysis of the data using a Bourdieusian framework aims to contribute to an improved understanding of how individual interactions both reflect, and serve to reproduce health inequalities in view of access, and more broadly.