Immigration Ethics

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Barriers to accessing care and ways to address them

Refugees and asylum seekers in the UK often have difficulty accessing healthcare and other public services. In many cases, they may be unfamiliar with the way these services are organised.

Overcoming these barriers is essential to providing effective care, improving health and wellbeing, and supporting refugees and asylum seekers to integrate into UK society.

Information on common barriers and options for overcoming them are provided for doctors working in:

  • all care settings
  • primary care
  • secondary care, including mental health services
  • maternity care.
  • All care settings

    NHS Low Income Scheme

    The NHS Low Income Scheme is open to all patients regardless of immigration status and provides financial help with medical costs, such as transportation to appointments and prescriptions.

    Many GP surgeries and hospitals will have copies of HC1 application forms for the scheme. It may be helpful to link patients with community support organisations who can assist them to complete the form.

     

    Local authority support

    In some cases, refused asylum seekers who are not being supported by the Home Office may be able to receive local authority support, even if they have no recourse to public funds. One reason for this is medical need. For example, taking medications which must be stored in a refrigerator will support a claim for housing.

    As a doctor, you may have a role in identifying these cases and advocating on behalf of particularly vulnerable patients.

  • Primary Care

    Refugees and asylum seekers often find it difficult to register with a GP. The most common reason is confusion among reception and administrative staff about who is eligible and what documents they need to register.

     

    Identity documents and registration

    Practices do not need to request any identity documents to register a new patient.

    However, some surgeries may ask patients to provide documents, including identification, proof of address and sometimes proof of immigration status in order to register.

    Such requests must be non-discriminatory. For example, they cannot be based on the applicant's race, gender, social class, age, religion, sexual orientation, appearance, disability or medical condition.

    Staff who register patients should be made aware of the difficulties refugees and asylum seekers may have in producing identity documents. They will need to be flexible about the documents they accept and include biometric residence permits or application registration cards from the Home Office.

    If a patient is not able to provide identity documents, it is not reasonable grounds to refuse to register them.

     

    Raising awareness among reception and administrative staff

    Practices should take steps to ensure that reception and administrative staff understand what is contractually required and do not incorrectly refuse to register vulnerable patients.

    Staff who register new patients should also be aware that they are not required to complete the appendix of the English GMS1 registration form relating to immigration status.

    Practices in England may find it helpful to have copies of this NHS England leaflet, which sets out the registration process for practice staff and patients.

  • Secondary care

    Refugees and asylum seekers are sometimes incorrectly denied or charged for secondary care because of confusion about their entitlement to NHS care.

    Our member survey found that 55% of doctors who work with refugees and asylum seekers were frequently or sometimes uncertain about their entitlement to care.

     

    Mental health services

    In some cases, refugees and asylum seekers may have difficulty accessing psychological therapies on the NHS.

    Local organisations, such as charities, may be able to provide medium-term psychological support, such as CBT (cognitive behavioural therapy) and community integration activities. However, not all therapies will be appropriate for patients with conditions linked to trauma, including PTSD.

    If a patient has complex mental health needs, it may be appropriate to refer them to a specialist service, such as The Helen Bamber Foundation in England and Freedom from Torture in England and Scotland.

  • Maternity care

    Female refugees and asylum seekers may have complex pregnancies, especially if they have experienced FGM or other forms of violence. It is important that they receive proper medical support throughout their pregnancies.

    Unfortunately, confusion about entitlement to care means that many women are afraid of being charged or turned away and do not engage with maternity services.

    You should make clear to your pregnant patients that all maternity services are considered ‘immediately necessary’ and must never be delayed or refused.

     

    Supporting consistent attendance

    Women who need to attend frequent appointments may have difficulty paying for transport. This is particularly true for asylum seekers who are supported by the Home Office and do not have access to mainstream benefits.

    Proactively exploring this possibility and any potential solutions with your patients can help to avoid missed appointments. For example, there may be local schemes to help vulnerable patients reach appointments.

    The NHS Low Income Scheme or local charities may also be able to assist.

     

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