Evaluating adherence to patient registration paperwork guidelines: a mystery shopper study in English primary care
Hodson, Nathan Onyeaso, Onyedikachi Oluferanmi Mills, Stuart Sunstein, Cass R Bruine de Bruin, Wändi
Hodson, Nathan
Onyeaso, Onyedikachi Oluferanmi
Mills, Stuart
Sunstein, Cass R
Bruine de Bruin, Wändi
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Affiliation
Warwick Medical School, Coventry; USC Sol Price School of Public Policy, Los Angeles; Coventry and Warwickshire Partnership NHS Trust; Leeds University Business School; Harvard Law School, Cambridge, Massachusetts;
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Publication date
2025-11
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Abstract
Objective: To evaluate adherence to National Health Service (NHS) patient registration ID guidelines among General Practitioners' (GP) practices.
Design: A mystery shopper study, including website reviews and phone calls.
Setting: Rural and urban parts of the United Kingdom's West Midlands.
Participants: 85 randomly selected GP practices.
Primary and secondary outcome measures: In January-April 2024, GP's websites were reviewed before phone calls in which our 'mystery shopper' was asked to register without photo ID and proof of address.
Results: Of 85 GP practices, 60 (71%) breached NHS guidance either online or over the phone, with only 25 (29%) consistently following NHS guidance. Phone calls to rural (vs urban) GP practices were more likely to yield refusal of registration without photo ID and proof of address, despite rural (vs urban) GP practices making similar statements online. During some phone calls, practices sought to negotiate a compromise by requesting less robust 'documentation', such as an addressed parcel.
Conclusions: GP practices commonly refuse registration to people without photo ID or proof of address, thus creating 'sludge' and undermining access to healthcare especially for poor, vulnerable patients, including immigrants. Changing GP practices' websites would not address this problem if erroneous information is still provided over the phone. GPs and practice managers should ensure that all staff follow NHS guidance to allow registration without these documents.
Citation
Hodson N, Onyeaso OO, Mills S, Sunstein CR, Bruine de Bruin W. Evaluating adherence to patient registration paperwork guidelines: a mystery shopper study in English primary care. BMJ Open. 2025 Nov 11;15(11):e100719. doi: 10.1136/bmjopen-2025-100719. PMID: 41224298.
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Article