COVID-19 & Access to Primary Care Services for Patients with “No Fixed Abode”
Author: Dean Spruce, Communication & Media Manager, VOICES
It has been known for quite some time that people that have no home are frequently wrongly rejected when applying to register with a GP in order to access primary care services.
Back in 2016 VOICES in collaboration with Expert Citizens CIC and Healthwatch Stoke-on-Trent undertook a ‘mystery shopping’ exercise resulting in the Gatekeepers Report, where 46 GP surgeries in and around Stoke-on-Trent were contacted and asked if they are able to register someone who is homeless. 47.8% of these said they could not (26.09% said maybe pending further advice with only 26.09% saying they could)
This is despite the CQC expected standards of care stating,
“CQC expects practices to register people who are homeless, people with no fixed abode, or those legitimately unable to provide documentation living within their catchment area who wish to register with them. 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 may also use the practice address to register them.”
“Practices should try to ensure they have a way of contacting the patient if they need to (for example with test results). Some areas will have special services for homeless patients and practices may refer homeless patients into those services in line with local arrangements where it is in the best interests and with the agreement of the patient.”
For people experiencing homelessness (who are more likely to die young with an average age of 47 compared to 77 for the general population) Primary Care is a critical touch point. It is an essential gateway and every effort should be made to enable access. Not being registered with a GP is a significant barrier to accessing other services that people experiencing homelessness often need (e.g. social care, mental health, addiction recovery services). This inevitably and unnecessarily adds to the pressures on acute services such as A and E.
Following the initial research conducted locally in 2016 a wallet sized card was produced and distributed locally which stated people’s rights when accessing primary care, that both customers and support workers could produce if access was refused.
A second piece of research – A Follow up to the Gatekeepers Report, was then conducted to establish if there has been any change in the willingness of primary care services to accept NFA patients compared to the findings of the Gatekeepers Report. The second report returned similar results with just 27% of the surgeries contacted able to give a firm yes when asked if they would register a patient of no fixed abode.
Back in December our colleagues at Homeless Link highlighted the importance of accessing primary care in the context of the current pandemic. Concern was expressed that without access to primary care people experiencing homelessness, who we know are, “substantially more likely than even the most deprived housed people to report having chronic diseases such as asthma, chronic COPD, heart problems and stroke” would be unlikely to be able to prove their eligibility for vaccination under the ‘clinically extremely vulnerable’ group identified by the Joint Committee on Vaccination and Immunisation.
However on the 11th March the JCVI updated their guidance having recognised that “People experiencing homelessness are likely to have health conditions that put them at higher risk of death from COVID-19” and are now advising the government to “prioritise people experiencing homelessness, including those sleeping rough, for the coronavirus (COVID-19) vaccine”, additionally and crucially, “without the need for an NHS number or GP registration.”
Groundswell have also done extensive work to provide Information about the COVID-19 vaccine and GP registration for people experiencing homelessness, having produced a number of resources for frontline workers which are available on their COVID-19 vaccine webpage.
We know that access to primary care is a long-standing issue for those experiencing homelessness, and we know there is still work to be done to tackle this inequality. We also know that If we act collectively we stand a much better chance of affecting the changes we want to see. In order to help facilitate this a complaint template that professionals can submit to NHS England if our customers are refused registration has been made available. Alongside Homeless Link we urge all professionals to download and use this every time one of our customers is refused access to primary care services.
In addition to this Expert Citizens CIC, in collaboration with VOICES and Healthwatch Stoke-on-Trent have produced a toolkit that outlines the methodology and processes undertaken to enable our research locally to be replicated. We invite professionals and organisation to download this and conduct comparable research projects in their own regions.
References & Resources
Homeless Link – ‘Now, more than ever, GPs must register those in need’
Homelessness kills: An analysis of the mortality of homeless people in early twenty-first century England
Joint Committee on Vaccination and Immunisation
Access to Primary Care Services for Patients with ‘No Fixed Abode’- A Follow up of the Gatekeepers Report
GP Access Cards
GP Registration Evaluation Toolkit
Groundswell Covid-19 Advice and Information