NHS Registration Policy

Registering patients
Introduction
Mitchley Avenue Surgery is currently running an open list for all new patients.

The practice boundary is pictured below.

Any out of area patients will be seen only if they require immediate and necessary treatment and will be registered as such on the clinical system. 

Eligibility for registration
It is practice policy that before any patient is successfully registered they need to conform to the details below:

•	We have a catchment area within which the patient must live.
•	We require their Full name, Date of Birth, Current Address and previous GP details.  
Identity verification requires two supporting documents, one of which MUST confirm that the patient’s address is within our catchment area and the other to show proof of identity.

•	Proof of identity – i.e.  A valid Passport, Photo Driving Licence, National Identity Card, Application Registration Card (ARC) and visa where applicable.
•	Personal Bank/Credit Card, National Insurance Card or NHS Medical Card.
•	Proof that the patient is ordinarily resident in the UK and have been for 6 months.  I.e. Utility bill, tenancy agreement, bank statement, council tax bill or other official/government correspondence verifying proof of address.

EVERYONE is eligible for:
•	EMERGENCY CARE
•	IMMEDIATE & NECESSARY TREATMENT

If the patient is seen by a GP under either of these categories it does not entitle them to permanently register with our practice.  Should the patient require further treatment, they can register with us with the necessary documentation.

Patients are entitled to the full range of NHS Services if they are ORDINARILY RESIDENT in the United Kingdom (i.e. in the UK lawfully, voluntarily and as part of settled life.)  This is irrespective of nationality, ethnicity or previous payment of UK taxes and National Insurance.

A person who intends to stay in the UK for less than six months would not usually be regarded as ordinarily resident and would therefore not be eligible to full registration.

Asylum seekers and refugees given leave to remain in the UK, or awaiting the results of application to remain, are regarded as ordinarily resident and entitled to full NHS GP treatment.

If a patient resides out of the UK for more than 90 days they MAY NO LONGER QUALIFY for the full range of NHS services.  There is often confusion as to entitlement where a person goes to live or work overseas and may return intermittently to the UK, for example for a holiday or to see family and friends.  A person who may be legitimately registered with a GP practice, but later decides to live, study or work overseas would not be entitled to continue to receive free NHS treatment, other than in an emergency if they returned to the UK for a holiday or short period before returning overseas.  They should have surrendered their NHS medical card when leaving the country.

This action does not preclude the patient from receiving treatment in an emergency or if they require Immediate & Necessary treatment.  If however treatment includes a hospital referral or any treatment delivered beyond Accident & Emergency in an Acute Hospital then it will be chargeable as a private patient.

It is strongly advised that patients arrange Private Health Insurance for future visits to the United Kingdom.

If the patient return’s permanently to the UK they can apply to register with us but you will be expected to demonstrate that they have returned to re-settle for more than 6 months.  Documentation as listed will be required.

** Save time and use on-line services ***

Benefits of registering for online services are: 
The ability to book appointments anytime ,order repeat prescriptions, view your test results and much more. Please ask the receptionist to activate your online registration.

Our practice leaflet can be accessed via our website. Please use the link below to view
http://www.selsdonparkmedicalpractice.nhs.uk/practice-leaflet,63225.htm

Tick the box to get signed up to online services via Patient Access 

Ethnicity
The Government requires us to collect data about the ethnic background of our patients. This information can help the Department of Health plan to meet the needs of the community and ensure that everyone has equal access to healthcare. Please note that we are not asking about citizenship or nationality but about the ethnic group to which you feel that you belong. Your care at the surgery will not be affected by your decision to complete or not complete this form.

Please complete the from below by ticking the box of the ethnic group you feel you belong to. If you feel you are descended from more than one group, please tick the one you feel you most belong to, or choose the “Any other ethnic group” box.

AO	White	British		
BO	White	Irish		
CO	White	Any other white background		
DO	Mixed	White and Black Caribbean		
EO	Mixed	White and Black African		
FO	Mixed	White and Asian		
GO	Mixed	Any other mixed background		
HO	Asian or British Asian	Indian		
JO	Asian or British Asian	Pakistani		
KO	Asian or British Asian	Bangladeshi		
LE	Asian or British Asian	Sri Lankan		
LO	Asian or British Asian	Any other Asian background		
MO	Black	Caribbean		
NO	Black	African		
PO	Black	British		
PD	Black	Any other Black background		
RO	Other ethnic groups	Chinese		
SO	Other ethnic groups	Any other ethnic group		

Main Spoken Language:	Religion:	

Marital Status:	Preferred pronoun:	

Your Name: ____________________________ Date of Birth: ____________________________

Home Telephone Number:		
Mobile Telephone Number:		
Email Address:		

Health Questionnaire
It often takes a few weeks to get your records from your previous GP. It would be helpful if you could answer the following questions so that we have some background knowledge of your health. Thank you. Please list any serious illness, operations or long-term health problems (EG: diabetes, blood pressure) that require medication:

Medication:  if you currently take regular prescribed medication please make an appointment with the GP to have these added to your medical records

Drug allergies:  

Nominated Pharmacy: 

Do you have any information or communication needs that we should be aware of?

I am deaf						Y/N
I require assistance with reading			Y/N
I require assistance with writing			Y/N
English is not my first language			Y/N

Are you a carer? Y/N 

If yes whom for: 

Your relationship to the above named:  
Smoking
We actively encourage all our patients to give up smoking, even if you have tried before or are pregnant, contact us for more information. 

Current Smoking Status:	Never smoked tobacco		
	Ex-Smoker		
	Cigarette Smoker		
	Rolls Own Cigarettes		
	Cigar Smoker		
	Pipe Smoker		
How many cigarettes/how many grams of tobacco do you smoke a day?		
Date Stopped Smoking:		
Past Smoking Status:	Ex trivial smoker <1 a day		
	Ex-light smoker 1-9 a day		
	Ex-moderate smoker 10-19 a day		
	Ex-heavy smoker 20-39 a day		
	Ex-very  heavy smoker 40+ a day		
	Ex-smoker unknown amount		
	Ex-pipe smoker		
	Ex-cigar smoker		
	Ex-rolled tobacco smoker		

Alcohol

What is a unit of Alcohol?
One unit of alcohol is:-
•	Half a pint of ordinary strength beer, lager or cider (3-4% alcohol by volume), or
•	A small pub measure (25ml) of spirits (40% alcohol by volume), or
•	A standard pub measure (50ml) of fortified wine such as sherry or port (20% alcohol by volume)

There are one and a half units of alcohol in:-
•	A small glass (125ml) of ordinary strength wine (12% alcohol by volume), or
•	A standard pub measure (35ml) of spirits (40% alcohol by volume)

Please answer the following questions:
Questions:	Scoring system	Your score	
	0	1	2	3	4		
How often do you have 8 (men)/6 (women) or more drinks on one occasion?	Never	Less than monthly	Monthly	Weekly	Daily or almost daily		
Only answer the following questions if your answer above is monthly or less:	
How often in the last year have you not been able to remember what happened when drinking the night before?	Never	Less than monthly	Monthly	Weekly	Daily or almost daily		
How often in the last year have you failed to do what was expected of you because of drinking?	Never	Less than monthly	Monthly	Weekly	Daily or almost daily		
Has a relative/friend/doctor/nurse been concerned about your drinking or advised you to cut down?	No		Yes but not in the last year		Yes, during the last year		

Height		
Weight		

Condition	Relative	Age at onset if known	
Heart Attack			
Stroke			
High blood pressure			
Cancer			
Diabetes			
Asthma			
Other serious illness (please state)			

Female Patients Only
Date of last smear:		
Result:		
Where did you have your smear test done:		
Date of last mammogram (age 50 or over):		
Mammogram result:		

Next of Kin/Carer
Name		
Relationship to patient		
Telephone number		
Email address		
Emergency contact?	Yes		No		

Consent

I give consent for the Practice to leave messages on my answerphone/send me a text message/email me and understand this will remain in force until I notify the practice to the contrary:

I understand that an email and messages may contain confidential information. The integrity and security of emails cannot be guaranteed on the Internet and an email at my place of work may be seen by colleagues. In the case of non-delivery, the email maybe forwarded to a general postmaster. Please remember to inform the surgery of any changes to your email address.

I give consent for the Practice to discuss any aspect of my medical treatments with the following person stated. I understand that I am consenting to the whole of my health record being available to those named below 

Name of third party ……………………………………………………………Relationship …...................................

Signed ………………………………………………………………… Dated …………………………………..
FOR STAFF USE ONLY

Patient Name:

Proof of name               	Proof of address	
Current signed passport                                                    	Utility bill (gas, electric, satellite television, landline phone bill) issued within the last three months           	
Original birth certificate (UK birth certificate issued within 12 months of the date of birth in full form including those issued by UK authorities overseas such as Embassies High Commissions and HM Forces)                                                      	Local authority council tax bill for the current council tax year                                                                                 	
EEA member state identity card (which can also be used as evidence of address if it carries this)                                                                                                                                                                                       	Current UK driving licence (but only if not used for the name evidence)                                                                 	
Current UK or EEA photocard driving licence
                                                                                  	Bank, Building Society or Credit Union statement or passbook dated within the last three months             	
Full old-style driving licence
                                                                                  	Original mortgage statement from a recognised lender issued for the last full year                                              	
Photographic registration cards for self-employed individuals in the construction industry -CIS4                                                                                	Solicitors letter within the last three months confirming recent house purchase or land registry confirmation of address                                                  	
Benefit book or original notification letter from Benefits Agency                                                     	Council or housing association rent card or tenancy agreement for the current year                                     	
Firearms or shotgun certificate                          	Benefit book or original notification letter from Benefits Agency (but not if used as proof of name)   	
Residence permit issued by the Home Office to EEA nationals on sight of own country passport                                                                                	HMRC self-assessment letters or tax demand dated within the current financial year                                    	
National identity card bearing a photograph of the applicant                                                         	Electoral Register entry                                                    	
 	NHS Medical card or letter of confirmation from GP’s practice of registration with the surgery                      	

Seen and verified by:- 	Name:

			Signature:					

Date: