Scores of GP surgeries are rated “good” by the Care Quality Commission (CQC) for the care they provide to vulnerable people despite wrongly refusing to register undocumented migrants, new analysis shows.
Health campaigners have raised concerns about the “lack of proper scrutiny” of GP practices that decline to register people because they cannot show ID or proof of address, after it emerged the health watchdog is rating them favourably despite its own guidance stating that registration should not be refused on those grounds.
An investigation by The Independent and the Bureau of Investigative Journalism in July found that fewer than one in four GPs across Britain would register someone without documentation or proof of address, even though NHS England policy states that documentation is not required.
A new analysis by the Bureau now reveals that 80 per cent of the GP surgeries that were found by the investigation to have refused patients in England (services in Scotland and Wales are monitored by different care regulators) are currently rated “good” by the CQC.
Of these, 77 are rated “good” for the quality of care they provide to “people whose circumstances may make them vulnerable”, while 79 are rated “good” and one “outstanding” for being “responsive”.
Among the questions CQC inspectors could ask surgeries when assessing the “responsive” rating is how they ensure vulnerable people – including refugees, asylum seekers, migrants and homeless people – are able to register with the practice.
James Skinner, interim co-director at Medact, said it was “shocking” that GP surgeries could be rated “good” while also refusing to register patients in contravention of national guidance.
“Without proper scrutiny from bodies like the CQC, discrimination and prejudice in the NHS will continue unchecked and it is migrant patients that bear the brunt of these institutional failings,” he said.
Anna Miller, head of policy and advocacy at Doctors of the World, said the current monitoring of GP practices did not sufficiently consider “the experiences of the most excluded people within communities”.
“It’s not good enough to just look at the experiences of registered patients – we need to think about people who are refused access to healthcare services altogether,” she added.
“The last year has shown us just how important it is for everyone to have good access to medical care when needed and how we can’t afford to cut anyone out of the healthcare system.”
Echoing these concerns, Avril Sharp, policy and casework officer at migrants’ rights charity Kalayaan, said it was “hugely worrying” that the CQC had not considered the impact of GP surgeries incorrectly turning people away, especially in light of coronavirus and access to the vaccine.
“The CQC must urgently tackle this problem head-on, identify it as a breach of Public Health England guidelines and work closely with GP surgeries to ensure access to healthcare is a fundamental right for everyone in the UK, and not limited to those with select paperwork,” she added.
The findings have also brought into question the efficacy of the current system for monitoring GP practices, with concerns that CQC inspections do not always identify where failure to register vulnerable patients is occurring.
A senior source at a London clinical commissioning group, who did not wish to be named, said CQC inspections sometimes proved to be “useless” because GP surgeries “know the pattern” and “know what to say” to inspectors in order to not appear to be breaching guidance.
“It is perfectly possible within this system to be able to produce documentation that says we have a policy that says we’ll register anyone, but actually, what happens at reception is something quite different,” they said.
The source added that some GP practices may refuse to register undocumented people because they want to “take on patients who can cause them the least amount of work”.
“There is a flaw in the system because it has allowed this, but there is also a flaw in the system because the monitoring is not as effective as it should be,” they said.
The joint investigation in July found that some 62 per cent of the 153 GP surgeries contacted refused altogether to register a dummy patient who could not provide ID documents or proof of address, while 14 per cent said they were unsure whether they could.
One woman with insecure status – a domestic worker and suspected victim of modern slavery – said she had been turned away three times since March 2021 when trying to register with GP surgeries because she could not show documents.
There are several reasons why insecure migrants might end up without proof of address or ID: their documents may have been lost during their journey to the UK, or stolen as part of abuse they have suffered since arriving in the country.
Undocumented migrants are prohibited from having UK bank accounts or renting, so they are also unlikely to be able to produce bank statements or tenancy agreements.
A CQC spokesperson said its ratings provided a “picture of the overall quality of care” being provided by a service, and that if it found evidence of discrimination on any grounds it would “take action to address this”.
“Everyone has the right to access care and GPs have a duty to provide emergency and immediately necessary treatment and should register patients without requiring any documentation. Most general practices do this,” they added.
“When we inspect GPs, we look at how care is provided to different groups of people including people whose circumstances may make them vulnerable. This includes asylum seekers, refugees and other vulnerable migrants.
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