Access to healthcare for overseas visitors

Health and access needs of vulnerable migrants

Location: England
Audience: All doctors
Updated: Monday 17 February 2020

The barriers that vulnerable migrants (including refugees, asylum seekers, refused asylum-seekers and undocumented migrants) can face when trying to access healthcare remain a concern.

See our guidance on Unique health challenges for refugees and asylum seekers.

 

Needs vulnerable migrants may have

Some refugees and asylum seekers may need specialist support because of the violence and trauma they have encountered.

Women remain at increased risk of sexual exploitation even after arrival in the UK, and it may be appropriate to explore adult safeguarding. They may also require specialist obstetric and gynaecological care, for example in cases of FGM. Early referral in such cases can be crucial to the patient’s asylum case as well as providing assessment for treatment.

 

Patients with limited English can find it difficult to engage with NHS services

For doctors, language barriers can represent a significant obstacle to providing safe and effective care. It is important therefore to use language interpretation services, ideally face to face, where possible.

It should not be assumed that patients would be willing to have their health discussed with their relatives. In some cases, individuals in exploitative situations could be accompanied by their trafficker/exploiter who will present themselves as a friend or relative.

Wherever possible, sensitivity should be exercised in selecting interpreters, with regard to factors such as gender, political or cultural background. Sensitivity in choice of interpreter is also advised in cases where patients need to discuss very personal issues such as sexual behaviour or sexually-related conditions.

 

Vulnerable migrants from countries with high prevalence of infectious diseases may get their first positive result in the UK

Such possibilities should be anticipated and discussed in advance with the patient. It will be important to explain to patients the nature of confidentiality in the UK, and that a positive result will not adversely impact on any request for asylum or immigration outcomes.

Local treatment commissioners, providers and public health teams should consider whether additional services and support are likely to be required in areas receiving large numbers of asylum seekers.

 

GPs should remain vigilant for early symptoms of communicable diseases in undiagnosed patients who seek help for other routine health problems

Patients’ vaccination history should be assessed and full immunisations offered according to current UK schedules for adults and children. GPs with a large number of patients who are vulnerable migrants may find it helpful to be in contact with specialist patient support organisations.

 

Some refugees, asylum seekers and other vulnerable migrants may arrive in the UK with poorly controlled chronic conditions following extended periods without access to regular care

In some countries, primary care is not well developed and some migrants may expect to be referred to hospital for relatively minor complaints, and for management of chronic conditions such as diabetes and hypertension. Sensitivity and skill are required to introduce them to the way medicine is practised in the NHS.

 

It is common for vulnerable migrants to present with non-specific complaints, such as headaches and stomach-aches

Doctors should explore with sensitivity the patient’s personal circumstances and history as these can be somatic manifestations of underlying mental health or social welfare issues. It may be helpful to link patients with support organisations with expertise in migrant welfare.

Resources