R67 – Ministerial Report from the Department of Health & Social Care; GP Registratio

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Andrew97
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R67 - Ministerial Report from the Department of Health & Social Care; GP Registration

This Ministerial Report outlines the Government's proposed changes to the way in which the public can register at GP practices. This report addresses the measures in VM606 - Student GP Registration Motion 2020, which was approved by the House in June 2020.

The following amendments will therefore be made to the The National Health Service (General Medical Services Contracts) Regulations 2015 under Schedule 3 (Other Contractual Terms):
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Part 2, Clause 18 (Application for inclusion in a list of patients)

The following clause is hereby amended:

FROM: 18.—(1) The contractor may, if the contractor’s list of patients is open, accept an application for inclusion in that list made by or on behalf of any person whether or not that person is resident in the contractor’s practice area or is included, at the time of the application, in the list of patients of another contractor or provider of primary medical services.

TO: 18.—(1) The contractor may, if the contractor’s list of patients is open, accept an application for inclusion in that list made by or on behalf of any person provided that person is resident in the contractor’s practice area.

FROM: (2) If the contractor’s list of patients is closed, the contractor may only accept an application for inclusion in that list made by or on behalf of a person who is an immediate family member of a registered patient whether or not that person is resident in the contractor’s practice area or is included, at the time of the application, in the list of patients of another contractor or provider of primary medical services.

TO: (2) If the contractor’s list of patients is closed, the contractor may only accept an application for inclusion in that list made by or on behalf of a person who is an immediate family member of a registered patient provided that person is resident in the contractor’s practice area.



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Part 2, Clause 26 (Removal from the list of patients registered elsewhere)

The following clause is hereby removed:

26.—(1) The Board must remove a person from the contractor’s list of patients if—

(a) the person has subsequently been registered with another provider of essential services (or their equivalent) in England;

(b) the Board has been given notice by a Local Health Board, a Health Board or a Health and Social Services Board that the person has subsequently been registered with a provider of essential services (or their equivalent) outside of England.

(2) A removal in accordance with sub-paragraph (1) takes effect—

(a) on the date on which the Board is given notice of the person’s registration with the new provider;

(b)with the consent of the Board, on such other date as has been agreed between the contractor and the new provider. (3) The Board must give notice in writing to the contractor of any person removed from its list of patients under sub-paragraph (1).


Official guidance will be provided to all GP practices across England to confirm these changes, which will be implemented on 1 January 2022.

Guidance issued to GP surgeries will include the following:
  1. To comply with Clause 18 (1) & 18 (2) of Schedule 3 (Part 2) of the The National Health Service (General Medical Services Contracts) Regulations 2015, prospective patients must provide the practice with proof of fixed address. Evidence of proof includes; a valid UK passport, a valid UK driving licence or a valid utilities or council tax bill from the last 3 months. Armed Forces personnel, the homeless, and those from outside of the UK either on holiday or currently awaiting an immigration status are exempt.
  2. GP Practices will be advised to register patients as 'temporary patients', if they expect to require primary medical services for a period of less than 3 months.


The NHS are currently in the process of running a competitive tender process to provide the facility for a universal software system, which will be used across GP practices in England to standardise the information available. This will enable medical records to be shared between practices.

As Health & Social Care Secretary, I believe this addresses the Motion recently passed by this House, ensuring that the public can register at more than one GP practice, but ensuring that all patients across England provide their GP practice with proof of fixed address.

I commend this Ministerial Report to the House
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SnowMiku
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I was a supporter of the original motion and am glad to see this report.

Regarding the "proof of fixed address" section, what happens in the case of travellers? Also, I'm not quite sure how a passport or driving license would prove that, unless it's just to show you're a British citizen, which doesn't fit the address bit. This does allow students to register at multiple practices, which is a good thing, but the wording here not so much.

I am undecided between Aye and Abstain.
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Miss Maddie
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Not until the relevant software exists. Multiple enrolment should only happen after the infrastructure is in place.
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Jammy Duel
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The technical limitations remain, I could also in theory be registered with every GP in the country. Obvioulsy in practice one couldn't because of the need to move home, but you could be registered with a great many at once which, other than the software limitations, will create funding head aches and potentially deny people access to a registration for no good reason.

The denial of access should be obvious, the funding issues is how are funds provided to the surgeries? If I am registered at two surgeries does that mean that I effectively cost double in terms of how much is paid to by surgeries or is it the amount the same as everyone else but is split? If it is split on what basis and does the software exist for that basis? If it is not split does the payment per patient decrease or the total amount given to surgeries increase? If per patient falls does this not penalise surgeries where all their patients are solely registered with that surgery? If the total amount granted is increased where is the money coming from?

It is obvious that little, if any, thought was given to the issues that might come about and how they should be resolved.
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abucha3
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(Original post by Miss Maddie)
Not until the relevant software exists. Multiple enrolment should only happen after the infrastructure is in place.
Multiple enrolment will be permitted after the implementation date of 1 January 2022, which provides enough time for a procurement procedure to take place and software to be rolled out across GP practices.
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abucha3
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(Original post by SnowMiku)
I was a supporter of the original motion and am glad to see this report.

Regarding the "proof of fixed address" section, what happens in the case of travellers? Also, I'm not quite sure how a passport or driving license would prove that, unless it's just to show you're a British citizen, which doesn't fit the address bit. This does allow students to register at multiple practices, which is a good thing, but the wording here not so much.

I am undecided between Aye and Abstain.
I am sorry to hear the the Hon. Member is not a firm supporter of this report despite supporting the original motion.

We did discuss this issue at Cabinet regarding the proof of address, but agreed that the list of examples I provided are not exhaustive, and therefore any official document which confirms proof of address for the last 3 months will be sufficient. A driving licence does provide a proof of address, however the reference to the UK Passport does cause confusion and will need to be removed (I am unsure whether I can have a Second Reading of an MR; if we can then this will be removed).

The Government maintains its commitment to ensuring that the homeless, those in the Armed Forces, and those here on holiday or are currently waiting on an immigration status will be exempt from the requirement to provide proof of address.

I do hope that the Hon. Member will be able to support the Government in the implementation of this Motion.
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Jammy Duel
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(Original post by abucha3)
Multiple enrolment will be permitted after the implementation date of 1 January 2022, which provides enough time for a procurement procedure to take place and software to be rolled out across GP practices.
Is 17 months enough though?

If it is then what went wrong with UC?
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Miss Maddie
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(Original post by abucha3)
Multiple enrolment will be permitted after the implementation date of 1 January 2022, which provides enough time for a procurement procedure to take place and software to be rolled out across GP practices.
The NHS has been trying to do this since 2005. £15bn later and it's still nowhere near ready. Why should 2022 be treated as a realistic deadline?
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Jammy Duel
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(Original post by abucha3)
I am sorry to hear the the Hon. Member is not a firm supporter of this report despite supporting the original motion.

We did discuss this issue at Cabinet regarding the proof of address, but agreed that the list of examples I provided are not exhaustive, and therefore any official document which confirms proof of address for the last 3 months will be sufficient. A driving licence does provide a proof of address, however the reference to the UK Passport does cause confusion and will need to be removed (I am unsure whether I can have a Second Reading of an MR; if we can then this will be removed).

The Government maintains its commitment to ensuring that the homeless, those in the Armed Forces, and those here on holiday or are currently waiting on an immigration status will be exempt from the requirement to provide proof of address.

I do hope that the Hon. Member will be able to support the Government in the implementation of this Motion.
Driving licences do not prove the address though. First of all while it is required to notify the DVLA of a change of address that does not mean they always are notified and therefore the address can still be wrong.

It also wouldn't work for students, unless this requirement to notify a change of address applies even for temporary accommodation, as per students which I'm pretty sure isn't the case (and there would be outcry if it were required) which means using your driving licence as a student you can only prove your home address and not your university address.
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abucha3
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(Original post by Jammy Duel)
Is 17 months enough though?

If it is then what went wrong with UC?
I would argue UC is far more difficult than this proposal. To consolidate a complex web of benefits into one single payment takes an awful lot of work, and I would say is probably more similar to the time it would take to simplify the tax system.

The public procurement process should take around 6-9 months, leaving just under a year to roll out the appropriate software. It should not need a bespoke system really, but more of a basic database system which can be shared across multiple sites in real times and is adapted slightly to suit the needs of the NHS. I think that could be done by 2022, but date can be flexible if indeed more time is needed.
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abucha3
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(Original post by Jammy Duel)
Driving licences do not prove the address though. First of all while it is required to notify the DVLA of a change of address that does not mean they always are notified and therefore the address can still be wrong.

It also wouldn't work for students, unless this requirement to notify a change of address applies even for temporary accommodation, as per students which I'm pretty sure isn't the case (and there would be outcry if it were required) which means using your driving licence as a student you can only prove your home address and not your university address.
A driving licence would be accepted as proof of address. It is an offence to not notify the DVLA of a change of address, and I would be hesitant to not accept this as a valid form of proof of address to mitigate the risk of people not complying with the law.

I am not sure whether students need to notify the DVLA if they change address to student accommodation, but the list I provided was not exhaustive; apologies, this should have been clearer. A student can, for example, provide a utility bill from the last 3 months at their student address and this would be accepted as a valid proof of address.
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Jammy Duel
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(Original post by abucha3)
I would argue UC is far more difficult than this proposal. To consolidate a complex web of benefits into one single payment takes an awful lot of work, and I would say is probably more similar to the time it would take to simplify the tax system.

The public procurement process should take around 6-9 months, leaving just under a year to roll out the appropriate software. It should not need a bespoke system really, but more of a basic database system which can be shared across multiple sites in real times and is adapted slightly to suit the needs of the NHS. I think that could be done by 2022, but date can be flexible if indeed more time is needed.
Is it really that complex from a software standpoint? Not really, the consolidation is a political decision and once that has been done the software just has to take those rules. Despite that it is looking to take 13-15 years from white paper to full implementation for UC, even on the initial timeline it was over 2 years just for the rollout to start with that rollout taking 5 years, so a total of 7 years originally to implement it fully.

That consolidation will have happened in the legislation, legislation from 2012, so from the details to the complete implementation we're looking at 12 years.

This is fundamentally a far more complex system because you are dealing with far more people (if only looking at England about 55m vs about 3m people for UC), the information needs to be readily accessible in many places, and perhaps most importantly the security requirements will be expected to be even stronger because not only are we talking about personal information in the form of thinks like your address, age, and NI number, but also your medical history.

Even if we accept this absurd idea that we could go from white paper to fully functioning and fully rolled out system in just 17 months what is the cost and where is the money coming from, new money or existing budget, if the latter then the NHS is going to be getting really pissed off because your coalition partners are already taking £750m from them.
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Jammy Duel
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(Original post by abucha3)
A driving licence would be accepted as proof of address. It is an offence to not notify the DVLA of a change of address, and I would be hesitant to not accept this as a valid form of proof of address to mitigate the risk of people not complying with the law.

I am not sure whether students need to notify the DVLA if they change address to student accommodation, but the list I provided was not exhaustive; apologies, this should have been clearer. A student can, for example, provide a utility bill from the last 3 months at their student address and this would be accepted as a valid proof of address.
The point isn't that it shouldn't be acceptable, but that for many it will not act as proof and for the people the motion was intended to help it would not provide proof of address.

Three years at uni, never had a utility bill (halls all three years)

Obviously a bank statement wouldn't work
No council tax bill
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El Salvador
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I of course support this MR.
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cranbrook_aspie
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I supported the original motion, but I think this goes a bit too far and is a little too ambitious. This allows anyone to register with any GP which is only going to lead, 5 or 10 years down the line, to surgeries’ records being clogged up with people who no longer live in their area and have simply forgotten to inform their old GP’s surgery that they’ve moved. I support this for students, and to a more limited extent for others who have multiple addresses, but the technical limitations and the potential for confusion are too much for it to be extended to the whole population.
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abucha3
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(Original post by cranbrook_aspie)
I supported the original motion, but I think this goes a bit too far and is a little too ambitious. This allows anyone to register with any GP which is only going to lead, 5 or 10 years down the line, to surgeries’ records being clogged up with people who no longer live in their area and have simply forgotten to inform their old GP’s surgery that they’ve moved. I support this for students, and to a more limited extent for others who have multiple addresses, but the technical limitations and the potential for confusion are too much for it to be extended to the whole population.
The idea is to allow everyone, not just exclusively students, to be able to register at multiple GP practices if they live elsewhere; I believe this MR does that, and does not go too far at all.

The whole premise of the Motion was that registering as a temporary patient was insufficient; that statement in itself was calling for a more wholesale change to the way in which we access GP services and I feel is delivered through this Ministerial Report.

I think, off memory, there was a clause within the National Health Service (General Medical Services Contract) Regulations 2015, about patients having not used a particular practice with 'x' number of years, which I think solves the query raised by the Hon. Member; I will check this though and report back.
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Rakas21
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I commend my colleague for the effort made to respect the will of the House here.
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abucha3
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(Original post by Jammy Duel)
The point isn't that it shouldn't be acceptable, but that for many it will not act as proof and for the people the motion was intended to help it would not provide proof of address.

Three years at uni, never had a utility bill (halls all three years)

Obviously a bank statement wouldn't work
No council tax bill
To the first point regarding driving licences, where the Hon. Gentleman says it will not act as proof for many, well that will be within their gift to manage. As Government, we are facilitating the ability to register at another GP surgery. If a student wishes to register at another surgery then they will need to provide proof of address, and if that means ensuring their driving licence is kept up to date then they will need to do that in order to register.

Would there not be a contract between you and the provider of the accommodation? I am sure they could provide a letter confirming if a student were living at halls. A phone bill? etc.
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abucha3
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(Original post by El Salvador)
I of course support this MR.
(Original post by Rakas21)
I commend my colleague for the effort made to respect the will of the House here.
I thank my Rt Hon. Friends for their support.
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abucha3
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(Original post by Jammy Duel)
Is it really that complex from a software standpoint? Not really, the consolidation is a political decision and once that has been done the software just has to take those rules. Despite that it is looking to take 13-15 years from white paper to full implementation for UC, even on the initial timeline it was over 2 years just for the rollout to start with that rollout taking 5 years, so a total of 7 years originally to implement it fully.

That consolidation will have happened in the legislation, legislation from 2012, so from the details to the complete implementation we're looking at 12 years.

This is fundamentally a far more complex system because you are dealing with far more people (if only looking at England about 55m vs about 3m people for UC), the information needs to be readily accessible in many places, and perhaps most importantly the security requirements will be expected to be even stronger because not only are we talking about personal information in the form of thinks like your address, age, and NI number, but also your medical history.

Even if we accept this absurd idea that we could go from white paper to fully functioning and fully rolled out system in just 17 months what is the cost and where is the money coming from, new money or existing budget, if the latter then the NHS is going to be getting really pissed off because your coalition partners are already taking £750m from them.
No, I would agree it should not be complex from a software standpoint. However, I think the issues and delays relating to the rollout of Universal Credit were from the technicalities involved of working out how to consolidate and assess a range of complex benefits into one single payment. I appreciate legislation commenced the process back in 2012, but it was not just looking at software rollout.

I think this should just be a software only rollout; there are not that many complications other than just storing information onto a universally accessible database. We are not looking at complex processes such as consolidation different types of benefits and mechanisms for working them out either, which adds further delays. The security arrangements could be covered by ensuring the software is encrypted; again by rolling this out through a procurement procedure, we will ensure the best possible supplier is tasked with providing the NHS with this software which is safe and secure.

I can also report that the Government will not be looking at removing money or funds from any individual NHS Trust or GP practice.
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