Patient Registrations

We would recommend that you give full and accurate information for each patient with a preference for information that would be already held on the Spine from previous practices or other healthcare visits. We are essentially making sure we have the correct patient at the right address.

We commonly use the code 3 rejection which is confirmation of the patient’s current address. You can use royal mails postcode finder or google to confirm that the address is valid or formatted correctly to make sure they can receive mail correspondence from the NHS.

Common reasons for rejected registrations - https://pcse.england.nhs.uk/sites/default/files/2023-08/10-common-reasons-for-registration-rejections.pdf 

Yes. If you do this we can ensure the patient is deducted from their Scottish/Northern Irish GP and ensure their records are forwarded on

This needs to be discussed with the patient, you should explain that NHS systems require a patient to have a forename and surname. For example, you could ask if a duplication of his first name in both fields is ok. If not, then you will need to come to some agreement with the patient on what can be used for their surname (such as XX). Something needs to be in this field when registering the patient, or the registration will be rejected.

The PCSE system now allows 'conflicting' title and gender/sex, so a patient can be known as the title they wish while remaining with their current gender. For example, a gender listed as male with a title of “Miss”. You can also state in the free text why the change is occurring so the registration team do not mistake the change as an error.

A patient’s gender can be changed to indeterminate or “I”.

Yes Mx is an accepted title. 

PCSE use Royal Mail’s postcode finder to help verify and format addresses. 

You can also use it to make sure the address is valid or formatted correctly. This is especially an issue for addresses with apartment buildings, flats, room separation, student accommodation and new builds.

PAF is the Postcode Address File which is supplied by the Royal Mail. You can verify addresses on the PAF via the Royal Mail Postcode Finder website.

Royal Mail Postcode Finder website: https://www.royalmail.com/find-a-postcode

If a patient is new to England or Wales from Scotland or NI, they are previously registered with the NHS, but they will be allocated a new number. 

If NBO trace their Scottish NHS number, you will receive a number amendment down the link.

For patients registering in England for the first time having previously been registered in Scotland, Northern Ireland or Wales, please select the registration type on your clinical system that you would if the patient was registering from another area of England and include their previous address. This will ensure that PCSE have the necessary information to request the medical record from the patient’s previous practice.

• PCSE will then process the registration and send confirmation to the practice via the clinical system
• The National Back Office will initiate the deduction of the patient at the previous practice which triggers the request for them to release the medical record for transfer on to the new practice
• The previous GP practice releases the record to the relevant Health Board who send the patient record to PCSE via courier
• PCSE locates the new practice details, and sends the patient record to the new practice via CitySprint, with their usual records delivery

Please note:

• GP2GP will not work for patients transferring from GP practices in NI and Scotland
• PCSE is reliant on the timely release of the patient record from the old practice in order to send it on to the new practice
• When a patient moves to Scotland/Wales/Northern Ireland/Isle of Man tracking labels are automatically issued. If they do not arrive within 3-4 weeks from the patients deduction, new labels can be requested.
• If the records are required urgently, please raise a query via the Contact Us page on the PCSE website, selecting Medical Record Movement enquiries & then "Urgent Medical Records enquiry" providing known details for the patient.

All patients that are moving to another home nation such as Scotland, Wales and Northern Ireland require the electronic health record printing to send with the Lloyd George envelope. This can be identified by the following labels.

The patient should be registered as usual.

If a sensitive marker needs to be put on the record, so that the patient cannot be traced, the practice should send an email to Pcse.registrations-preston@nhs.net with the request. 

PCSE will send a form to be completed, and will then forward the request to NHS England to set the flag. 

PCSE are required to match patient addresses to the Postcode Address File (PAF) to ensure their quality given the importance of the data to patient communications from the NHS. PAF is only updated periodically and therefore new build properties don't always appear before people begin registering as a resident.

This can therefore cause some confusion at PCSE, who are unable to trace a patients address on PAF. If an address is amended by PCSE and this is not correct, or if an address is queried by PCSE during processing of GP links messages, please resubmit the address information with a free text message stating 'Address Correct - New Build Property.'

Patients within the adult male, adult female and children and young people’s secure estate (adult male prisons, adult female prisons, young offender institutions and secure training centres) have the opportunity to register with healthcare at their place of detention. This means a GP2GP transfer can take place, electronically transferring the patient’s community GP record into the clinical system in place across the secure estate, and then back out to the community when the patient registers with a GP on release.

Please visit the Detained Estates webpage with more information.

Private patients without an NHS number 

If you are registering a patient who has previously been private, they may not have an NHS number. The new style of NHS number only came into fruition in 1995, therefore if a patient was born prior to this and not registered with an NHS GP at the time, they will have not been issued one.

The PCSE Registration teams are required to search for possible matches to the details provided. By providing a previous address for a patient, possible matches can be found quicker. If there is a possible match, the team will reject back to the GP practice for them to review, update and return the registration with the required information. If the information isn't clear or if there is not the information provided, it means further delay or rejection. Please also note in the GP message field ‘Private patient not previously registered with the NHS'. This will limit rejections if no trace of the patient is found.

Private patients with an 'inactive' NHS number

If a patient does have a NHS number, but this has been 'inactive' due to the patient being registered privately, this registration requires extra investigation or tracing completed by the National Back Office (NBO).

NBO have 15 working day SLA. This means registrations can be delayed up to 25 working days inline with our KPI's, although typically we are working an 18 working day SLA. There is no escalation process with NBO or a process to communicate to the GP practice about the delay.

What should I do if I have unacknowledged registrations?

Please check your unacknowledged file every week. For any patients that have been unacknowledged for 10 days or more please contact PCSE with;

• The patient's name
• Date of birth
• NHS number if known
• Your practice code

Please note that over 95% of registrations are processed within 3 working days but data quality issues mean it can take up to 10 days to process a registration.

If a registration has not been acknowledged within 10 days, there may be an issue with the receipt of the registration through GP links, or transmission of the acceptance message to your clinical system that needs to be investigated and addressed.

You should never use the high security/security controlled procedures functionality on your clinical system to approve a registration in your unacknowledged file unless advised to do so by PCSE.

I have transaction numbers but do not know which patients these relate to.

Please check your unmatched file every week. You will need to email us with a list of your unmatched transaction numbers along with your practice code so that we may assist you. 

Please note that ‘Approval’ unmatched transactions often appear because there is no matching patient in your unacknowledged file when PCSE have processed a registration.

This indicates that a patient’s registration has been approved under high security/security controlled procedures. An action that should not be undertaken unless advised to do so by PCSE. Doing this action can result in patients showing as active on your clinical system when they are not registered on the system used by PCSE and/or PDS Spine. This can have clinical implications to patients and financial implications to the practice.

When can a patient register at a practice as a temporary patient?

For the first 24 hours a patient can be treated as immediate and necessary, and a temporary Registration (GMS3) can be in place for up to 3 months. A GMS3 form will need to be completed by the patient.

My practice needs an NHS number for a temporary patient.

PCSE registrations only deal with permanent registrations sent through the GP links.  Registrations for temporary patients should not be sent via the GP links.

If the practice requires guidance registering a temporary patient on their clinical system, they will need to seek guidance from their system supplier.

Due to patient confidentiality PCSE are unable to confirm the NHS number for a temporary patient, this information can only be given to the registered GP practice.

A GP at our practice wants to refer a temporary patient and they need the patient's NHS number.

Temporary patients cannot be referred through practice systems.  Should a temporary patient require referring, the GP needs to contact the Service Provider directly.

Alternatively, if the practice are happy to do so, they can register the patient as permanent by submitting the patient’s registration via the GP links.

Should we register a patient as temporary and for how long?

If the practice are unsure whether or not they should register a patient as temporary please contact NHSE local area team for guidance.

Where can I get information about GMS3 forms?

Please see the Medical Records section for information regarding the GMS3 forms.

When searching for a new patient using your clinical system it is important to use the exact details provided by the patient as there may be two or more patients with very similar details.

If you are unable to trace the patient’s NHS number, please note that PCSE are unable to provide you with the patient’s NHS number until a registration has been received via the GP links and has been processed.

Please note that it takes up to 24 hours for a transaction to reach PCSE once it has been submitted by the practice.

You do not need to include an NHS number on a patient’s registration for it to be processed as long as you have included the following essential information.

Ensure that you include:

• the patient’s full details including place of birth (unknown not acceptable)
• previous addresses
• previously registered GP surgeries

This will help us find a match on the national spine. 

Once the transaction has been processed by PCSE, you will receive the NHS number for the patient via the GP links.

Immigrants - first time registration

If the patient is an immigrant and this is their first registration in the UK, then please include their place of birth.

Please do not provide a previous address on the registration of an immigrant unless the patient has confirmed they have previously been registered with the NHS. If they have been registered previously then their previous address must be provided.

Please note: As part of a visa or immigration application, patients may pay the immigration health surcharge. This results in them being allocated an NHS number before they arrive in the UK.  These will show on the National Spine but not linked to practices and their address will show as ‘address not known’. 

Patients that were born in the UK but have been out of the country for a number of years

If the patient was born in the UK and has lived abroad since pre 1996 please register the patient as an immigrant ensuring the dates that the patient left the UK and entered the UK are provided.

Private Patients

If you are registering a private patient for the first time i.e. they have not been registered with the NHS prior to the mid 90’s, please put a note in the GP message field write ‘private patient not previously registered with the NHS.’

Guidance on Residential Institute (RI) Codes

Adding a Residential Institute (RI) Code to a patient record is the responsibility of GP practices.

When a registration or amendment is received with an RI code it is PCSE’s responsibility to ensure the address that the patient is registered at is a care/residential home, and therefore whether the patient is eligible to have the RI code flag added to their record.

Following the transition of registrations activity to a new a system (PCRM) which was completed in July 2024 a single use RI code was mandated for use in GP Links messages. This code is V0. No action is required from practices to correct any existing care/residential home entries on the clinical system as suppliers were asked to implement a change that mandated the use of V0.

In addition to the introduction of the new RI code, practices no longer need to notify PCSE of new homes in their area. A list of homes/care facilities are stored within Spine and PCSE use this reference data to check if residents of the address are eligible to have the flag applied. If the premise is not listed further checks are undertaken.

Flagging patients with an RI code will help to ensure that practice global sum payments are calculated accurately.

If you believe PCSE are removing RI codes from patient records incorrectly when GP links transactions are being processed please email our queries team pcse.registrations-preston@nhs.net or by completing the Registrations ‘contact us’ online form. Please always include your practice code and any patient specific information to allow us to respond to your query on first contact and as quickly as possible.

Please note that a single use code for students was also introduced at the same time. This code is Y0. Students should be flagged as such for identification purposes only. They do not impact practice payments.

Please register the patient as normal. In the field for the patient’s address, please enter the full address for the GP practice including the practice postcode, putting CO (Care of) at the start of the address.

Please note, putting ‘no fixed abode’ in any field would cause the registration request to be rejected.

If the homeless person is residing in a hotel, hostel or other accommodation, please put the room number. 

Practices should only use High Security when requested to do so by PCSE. 

Any actions carried out under High Security update the clinical system ONLY and results in no GP links transaction being sent to PCSE. 

High Security should only be used as a corrective measure for failed GP link transactions. 

Typical examples of when High Security should be used are as follows:

1. Patient is active on the clinical system but not registered with PCSE

This indicates that a patient’s registration has been approved under high security. Practices should manually deduct the patient under high security using their security password, come out of high security and then send a new registration through the GP links system as if they are registering them the patient for the first time.

2. Patient has been deducted by PCSE but remains registered on the clinical system

This indicates that no deduction has been received through GP links and therefore the practice is required to manually deduct the patient under high security.

3. Patient’s registration is unacknowledged on the clinical system but is registered with PCSE.

The practice needs to manually approve the registration under high security. This will remove the patient from the ‘unacknowledged list’ on the practice’s clinical system.

If assistance is needed in manually deducting/approving registrations, please contact your clinical system supplier.

Please note:

• All deductions should be sent via the GP links system
• Patients should not be manually deducted from your clinical system unless this is requested by PCSE
• Manual deductions made under High Security will only remove the patient from your clinical system and will not remove them from the national spine system or PCSE system records. All three systems should match
• In the event that a manual deduction is made under High Security, please inform PCSE via email, stating the reason for the deduction and a forwarding address for the patient.

Please contact us to assist you with this.

Registrations are usually processed by PCSE within 3 working days but it can take up to 10 working days. If you have not received an acknowledgement to a new registration within 10 working days this indicates there may be an issue with the GP link and you should contact us to check the status of the registration.

The patient will only receive a confirmation letter for a registration of a birth, or if they have never previously been registered with a GP practice and have a first time registration.  Immigrants, and people registering for the first time after moving into the country will also receive a letter.

We are aware that practices may wish to register Afghan refugees, who may not able to provide the usual information required to register them. 

Please call the Customer Support Centre on 0333 014 2884 and press 6 for Patient Registrations queries. You will need to provide the customer service agent with the following information as a minimum:

• Title
• Forename
• Surname
• Address
• Date of Birth *
• Gender 

* If date of birth is not known, the practice should use 1 January and the year they think the patient was born.

These cases will be handled as high priority. 

If you do not have this information, we are unable to raise a case. In this circumstance, practices should contact their Area Team or Commissioner.

New registrants include babies, patients recently arrived from overseas and any other patients who have an NHS number allocated for the first time at the point of registration.

As part of NHS England's push to digitise medical records the issuing of new medical record envelopes (Lloyd Georges) for patients registering with the NHS for the first time has now been ceased.

Any registrations processed after the 1st January 2021 for these groups will not be automatically issued with a physical medical record as previously occurred. Practices that are unable to scan notes onto an electronic record are still be able to order a Lloyd George for transferring records.   

PCSE will then send a new registration letter directly to the patient’s home address.

Replacement registration letters or medical cards are not provided. If a patient needs their NHS number, they can get this from their current GP.

We wanted to confirm that people coming to the UK from Ukraine will already have an NHS number as these flow from the visa process.

Please ensure you search for an existing NHS number e.g. at the point of GP registration, taking care when translating names from Cyrillic to English text.

There may be some exceptions, due the circumstances of an individual’s arrival in the UK, where a new NHS number needs to be requested.

If the individual and/or their family are residing in a hotel, hostel or other type of accommodation with multiple rooms, please put the room number when registering.