When Fr. Steven Saxby realised that several members of his congregation had been refused registry with their local GPs and denied access to essential health care due to their immigrations status, he decided to do something about it. He organised an immigration and health care training for some of the congregation at St. Barnabas Church in Waltham Forest after the Sunday mass.
St. Barnabas Church is actively working to provide support to its congregation with diverse migrant backgrounds, as part of its ongoing work to tackle issues faced by vulnerable migrant members. I have been involved for some time in this work, and was curious how we as a community could improve the situation with regards to health.
The training was led by Fizza Qureshi, Programme manager of Project: London, Doctors of the World, and she like the church members identified the main barriers to health care access as the difficulties in providing proof of identity and address as well as fear of being reported to UKBA by health care authorities. This is a particular concern for those who are undocumented.
But many migrants don't know that they have a right to access health care. The training therefore covered rules and regulations on access to NHS health care and data protection, and tips for GP registration. The participants learned of key NHS constitutions, which states that the NHS is to provide a comprehensive health care service to all regardless of race, gender, sexuality, religious, disability and so on - and regardless of immigration status.
They also learned that the service is based on clinical need, not on one’s financial capability. Participants were informed how primary and secondary care are categorised and practised under different laws and regulations. They learned that primary health care, is free and that everyone has access to it, it is not restricted by any laws or regulations. Secondary care (specialist treatment), however, can be chargeable depending on a patient’s immigration status. Participants learned of the criteria for access to free secondary care such as their length of stay in the UK and immigration status.
Despite the right to basic primary care, however, the reality is that many migrants – including many of the St Barnabas congregation, have been unable to consult GPs because they were asked by the GPs office to present their valid passport or visa as a proof of identity. Some individuals did not have a passport, and some who were undocumented were afraid of being reported to UKBA if they showed their ID or address. ‘There is no law requiring you to present your passport or visa in order to register with a GP. If a GP or a staff of the practice contacts UKBA to discuss about your case without your consent, he or she is breaching medical data protection and patient confidentiality, and that’s illegal’, Ms. Qureshi told members of the church.
Even so, what is tricky is that all GPs have the discretion to accept or refuse any person as an NHS patient although they must not discriminate against certain groups of people. In other words, GPs have the right to choose their registered patients, and often the decision is made based on one’s ability to provide the documentations they ask to see from new patients. This is why the training also provided practical tips on negotiating with GP practices and challenging unlawful refusals:
These tips might be helpful for many others in contacting their GP practices, so I am including them here:
Call your local GP practice before you actually go in, and ask if they are still accepting new patients (you can say that you are calling on behalf of someone) – this is important to do at first so that they cannot tell you that the list is closed after finding out you cannot provide the documentations they ask for.
Ask about documentations for registration and if they ask you for documents that you cannot provide, ask them why they need it and use your knowledge about the laws (e.g. you can explain that there is no law requiring individuals to show a valid passport or visa for registration).
Explain why it is difficult for you to get the documents they request from you and focus more on the medical needs you have.
Acknowledge the difficulty the receptionist may be facing, and ask to speak to practice manager or the GP if the negotiation gets difficult.
It is always important to have the name of the person you are speaking.
“If you do not have any form of proof of identity and address such as a driving licence, utility bills and bank statements, Project London offers to provide a letter to confirm your identity and address, which should be treated as an official documentation”, Ms. Qureshi explained.
Even if a GP still refuses you for registration, they are legally obliged to provide emergency consultation and care for a maximum of 14 days free of charge. It is also important to know that the GP is obliged to provide reasons for refusal in writing. You should always ask for this in the case of refusal as it will be used when challenging unlawful refusals.
“Providing official confirmation of identity and address is something that we can do as church. For members who do not have fixed address, I will be very happy to let them use the vicarage as their corresponding address”, Fr. Saxby told to the attendees. “I want to bring what we learnt into action, share the information and collect strength to work with others. We have gained great knowledge in order to carry on our ongoing work.”
A church member, who had previously been refused registry with a GP said “the training has given me more confidence to try again - I was rejected twice before. When they asked me for my passport or national insurance number, I could only give up and turn my back. Now I know my rights and that they don’t need those documents. I want to share this information with more friends who are in the same situation.” Another member said “the training was very informative, and I just feel like popping in one of the surgeries and try the strategies we learned today. It’s fulfilling to know that I have rights. We should organise workshop with other members to practice how to negotiate!”
Information on Project:London’s ‘Access to Health Care Workshop’ is available at http://www.medecinsdumonde.org.uk/projectlondon/accesstohealthcareworkdshops.asp