Manchester’s Safe Surgeries: helping the most vulnerable get GP care

A charity is aiming to reverse shocking statistics showing that exclusion from GP services is widespread.

Manchester Safe Surgeries are ensuring that some of society’s most vulnerable people are able to see a doctor.

The initiative is run by the charity Doctors of the World, which is currently celebrating setting up 500 safe surgeries across the UK.

The charity’s national health advisor, who lives in Manchester, spoke about her work helping to set up Safe Surgeries in the city and explained why they are needed here.

What are Safe Surgeries?

A safe surgery is any GP practice which commits to taking steps to tackle the barriers faced by many vulnerable people in accessing healthcare.

The biggest issue is around patients needing to hand over certain details about themselves before they can register.

Shocking figures amassed by the Bureau of Investigative Journalism in collaboration with a national newspaper found that just under one in four GP surgeries surveyed across England, Scotland and Wales were prepared to register a patient without proof of address, proof of ID or legal immigration status.

This puts up massive barriers to accessing healthcare for people such as asylum seekers, refugees and street homeless people among others in extremely difficult circumstances.

A doctor with a patient

Safe surgeries pledge to ensure that there are no barriers to patient registration and no-one is excluded.

This could also mean addressing language and administrative problems people face.

Everyone living in the UK is entitled to register and consult with a GP.

But the charity Doctors of the World, which launched the Safe Surgeries scheme in 2018, say people continue to be excluded and prevented from accessing healthcare even though they have a right to it.

What is happening in Manchester?

The charity’s national health advisor, who asked to remain anonymous due to her involvement with the asylum system, spoke about the barriers people such as refugees and asylum seekers face.

She urged more surgeries in Manchester to consider signing up for the Doctors of the World scheme.

Refugees and asylum seekers have joined the Rapar (Refugee and Asylum Participatory Action Research) scheme can be put into a WhatsApp group where they can discuss their mental health, physical wellbeing and any problems they are experiencing.

Within these groups a number of stories are shared about the difficulties people face when trying to get healthcare.

She said: “From time to time we get new refugees and asylum seekers who join Rapar and they are not registered with a GP for various reasons such as language, not knowing how to access the service, fear of being reported to the Home Office, fear of having to pay, and so on.

“Within the groups I work with, I hear a lot of issues they face from GPs from not being able to register to not being heard, ignored, not understood, not being treated right, being charged for services or receiving letters to pay fees if they have had to access emergency services.

“These make some migrants so depressed that they simply can’t be bothered to even want to get their health checked. “

She said she is a trustee and leader for a mental health group and supports Doctors of the World by promoting its policies such as Safe Surgeries, steering campaigns and getting involved with activities to influence its work.

Despite the ongoing issues, though, increasing numbers of Manchester doctors are signing their surgeries up to the scheme.

However, while the city is one of the places leading the way across the country for the initiative, there is always more to do.

How serious can the lack of healthcare access be?

The charity’s advisor told a story from Manchester which illustrates just how big a problem vulnerable people not being registered with a GP can be.

She said: “A member who had serious heart condition and was in an emergency, critical situation, did not want to go to A&E as she was scared of being charged and not being seen by a doctor.

“She was destitute and did not have any money, and she was refused asylum application by Home Office and she didn’t have a place to live.

“We see heart-breaking stories daily and we are doing our best to change as much as possible but I feel the situation hasn’t changed much since I was an asylum seeker.”

Should Manchester GP surgeries sign up to the scheme?

The advisor spoke of her belief that GPs across the city should be interested in making their practices safe surgeries and explained why.

She said: “If GPs are educated about migrants’ entitlements to primary care around the UK this will have a big impact on who will then access their services.

“I feel this is something that all Manchester GPs should be actively involved in, not only by getting themselves trained in this but also training junior GPs and foundation doctors and their whole practice staff.

“Manchester Safe Surgeries simply follow the NHS England policy and guidance and do not insist on proof of ID or address and never ask immigration status ensuring there are no barriers for migrants to register.

A stethoscope in a GP’s surgery. Photo by Carl Court/Getty Images

“Through becoming Safe Surgeries and completing training GP practices change their attitudes and registration policies in a way to offer support and not refuse registration request of a migrant who cannot provide a proof of address, or who cannot speak English.

“This helps doctors to uphold their Hippocratic oath of ‘’first do no harm’. Not registering the refugees and asylum seekers because they cannot provide documents is essentially harming them first hand by refraining them from the healthcare they are fully entitled to.

“They would be harming the minorities (refugees and asylum seekers) if they don’t have an awareness around vulnerable circumstances that many migrants in, and if they don’t register them to access health care.

“I know with the help of the Clinical Commissioning Group many GP practices joined Safe Surgeries and completed training earlier this year making Manchester one of the leading cities in Safe Surgeries initiative, which is promising but I think all GP practices should be a Safe Surgery so Manchester leads the way in inclusive healthcare.

“Awareness and education is a must if we are to do no harm. “

What are the benefits to GPs of becoming Safe Surgeries?

Doctors of the World says that as well as the opportunity to better advocate for patients, becoming a Safe Surgery offers GP practices additional benefits:

These include support to fulfil contract obligations as defined in NHS England guidelines such as preventing ID and proof of address being barriers to registration, and support towards successful inspections by the watchdog the Care Quality Commission (CQC) by helping practices deliver an effective, responsive and caring service.

Becoming a safe surgery also supports staff learning and skills-building through free training, information-sharing and resources.

It also makes practices members of a community of providers promoting a better NHS, helping to tackle health inequalities and providing accessible healthcare for those who need it.

To find out more, including how to register for the scheme, visit the Doctors of the World website.