Turned Away

Turned Away: new research from Nacro shows the barriers to accessing primary healthcare for prison leavers and other marginalised groups.

Prison leavers, people experiencing homelessness are just some of the groups who are regularly experiencing issues accessing GP and healthcare services according to new Nacro research.

This is because they are less likely than most to have proof of ID or proof of address, which over 40% of GP surgeries we surveyed said was a requirement to register as a patient.

However, neither proof of ID nor proof of address are needed to register under NHS official guidance.

It was particularly disappointing to note that 58% of GP practices rated as ‘good’ said they required proof of address to register a prison leaver, and even more disappointingly that four out of the five GP practices rated as ‘outstanding’ also still required proof of address.

Why does it matter?

During Care Quality Commission (CQC) inspections, a practice is assessed on its safety, care, responsiveness, and inclusivity. Considering the above data findings, we would question whether the needs of marginalised groups are fully considered in CQC inspections.

People in prison have higher health needs than the wider population, with a higher prevalence of infectious diseases, mental health issues and substance misuse issues.

A lack of health support can lead to further offending. If people coming out of prison are unable to access the support and medication that they need, they are more likely to fall back into old patterns of behaviour: for example, returning to depending on illegal substances and committing crimes to support those needs.

Nacro runs wellbeing support services which help people leaving prison access healthcare services, housing, mental health support and more.

66 %

of GP practices said proof of address was required to register
43 %

of GP practices said ID was required to register
41 %

of GP practices required both ID and proof of address for registration

John’s Story

John has a diagnosis of borderline personality disorder, and has struggled with suicidal ideation and substance misuse. He needed to register with a GP after he was released from prison, but was told by the local practice that he could not do this as he did not have any ID or a copy of his tenancy agreement. His support worker contacted the practice on John’s behalf and was told they were unable to register anyone who could not prove that they lived within the catchment area.

The support worker referred to the NHS guidance, but the practice manager continued to insist on proof of address and an ID document. The support worker offered to provide a letter confirming that she could verify John’s identity, but was told that this was not sufficient. John was then able to make contact with a family member who was able to provide him with his birth certificate but was advised by the practice that photo ID was still required.

The support worker again contacted the practice and explained the situation and his circumstances. The practice asked if they could call back later. A few days later the surgery called back to say that under these exceptional circumstances they would agree to register him. It was only then that John’s medication was reviewed and a referral was made for counselling support.

Support worker’s view

Fiona Bowe is the wellbeing service manager for Nacro, she said: “We often have to battle to ensure that people can be registered with a GP when they leave prison so they can get the vital medication and support that they need.

“Without the right support in place it is easy for people to fall back into old patterns of substance misuse as they do not have the help, they need to maintain their journey away from addiction. Not everyone has the support of someone that is able to advocate on their behalf.”

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Find other Nacro research and reports here