Daily Insight: Out in the cold

An investigation by HSJ has found that national rules intended to ensure homeless and excluded people have access to healthcare have been breached by two-thirds of London GP practices from a sample of 100.

The practices declined to register a patient without an address, even though NHS England guidance states anyone can register with a GP without proof of address, and that people without a permanent address “can still register using a temporary address or the address of the GP surgery”.

Practices normally need to record an address, but the exception rule is meant to ensure people who are homeless, or living in unstable or short-term accommodation, are still able to access primary care or referrals for secondary services.

Despite this, when HSJ called 100 randomly selected practices in London (about 9 per cent of the total), 64 refused to register the caller.

The “mystery shopper” told receptionists at each GP that they did not have a permanent address but were living temporarily in the local area, and would not be able to provide an address. If declined registration, the caller informed the call handler of the NHSE guidance and advice, giving them a further opportunity for them to agree or check with colleagues.

The reasons for refusal varied, with many practices stating their computer system could not process registrations without an address. One receptionist said they “could get in trouble for registering someone outside of their catchment area”.

Not going down without a fight

Preventing a provider from carrying out a regulated activity is one of the toughest actions the Care Quality Commission can take – and can have profound implications for independent sector companies who will lose income and potentially contracts as a result.

But sometimes providers will come out fighting. Specialist Medical Transport challenged the CQC at a first tier tribunal after its northern division was unable to carry out work for nearly three months following a critical inspection.

It successfully argued that the CQC had misunderstood the nature of a key part of its work – transporting mental health patients – and that much of its criticism was invalid. While there were still improvements to be made, the tribunal found the CQC’s actions were not “necessary, reasonable or proportionate” and allowed the provider to operate again.

Somewhat confusingly, the CQC then published a final report which contained many of the same criticisms and rated the operations in the north as “inadequate” without mentioning the tribunal. The company now plans to challenge this through a judicial review but the CQC also announced it will appeal the case to the second tier tribunal.

Critics of the CQC have already ordered in popcorn for this next round.