“Think Global, Act Local”Migrant Health in the UK

Dr Shazia Munir13th April 2012, RCGP JIC AGM

“Think Global, Act Local”Patrick Geddes, 1915

urges people to consider the health of the entire planet and to take action in

their own communities and cities

• Salaried GP Elephant & Castle, London • Beyond Europe Lead JIC• Volunteer GP, Project:London, Doctors of the

World UK • Medico-Legal Doctor, Freedom From Torture

Home or away?

• International work – barriers

• Preparation for overseas work

• “Think Global, Act Local”

Combining General Practice with International Work: Experiences of UK GPs, Chris Smith et al.

Migrant Health in the UK

Migrant Health in the UK

1. Migrant health needs2. Who is entitled to NHS Primary Care?3. Who is entitled to NHS Secondary Care?4. How can you get involved?

• Refugee: a person who is outside their country of origin or habitual residence because they have suffered persecution on account of race, religion, nationality, political opinion, or because they are a member of a persecuted 'social group'

• Asylum seeker: a person who is making a claim/request for refugee status

• Refused asylum seeker• Undocumented migrant

Migrant Health Needs

• Bread and butter GP• Immunisations• Communicable diseases: TB, HIV, Hepatitis B

and Hepatitis C• Psychological needs: depression, PTSD

• Generally young & fit: 3 years in UK before sought healthcare

Primary Care

Primary Care• There are no regulations

regarding charging or eligibility

• NHS (GMS Contract) Regulations 2009, Schedule 6, Paragraph 17

“...general discretion to register/refuse to register anyone in catchment area, so long as GP does not discriminate...”

Primary Care: Other guidance• The BMA’s General Practitioners’ Committee’s Guidance, which was issued

in Jan 2012 sets out the extent of the discretion that GP’s can exercise.

• The General Medical Council’s Good Medical Practice makes clear that the care of the patient should be the paramount consideration, not whether they are an overseas visitor or not.

• The Royal College of GPs states: Based on the principle that General Practitioners have a duty of care to all people seeking healthcare, the RCGP believes that GPs should not be expected to police access to healthcare and turn people away when they are at their most vulnerable…  In addition to failed asylum seekers, we would urge the government to consider the health needs of other vulnerable migrant groups, who we feel should also be entitled to free primary care.  Pending further legal clarification, the RCGP reminds all general practitioners that failed asylum seekers are entitled to unrestricted access to primary care services.

Primary Care

• So a GP can register– ANYONE - AT GPs DISCRETION– Refugees and asylum seekers– Refused asylum seekers– Overseas visitors– Other undocumented migrants

Primary Care: Legal situation

• If a GP refuses to accept a person they are legally obliged to provide emergency treatment (immediately necessary) treatment for a maximum of 14 days.

• PCTs are not allowed to challenge a GP’s decision to register someone. If a PCT attempts to challenge a GP’s decision this could then be legally challenged.

Secondary Care

Secondary Care

Entitled to free treatment• Asylum seekers• Refugees• EEA nationals• Dependency visa• Work/ Student visas• Those from countries with

bilateral health agreements• Victims of human trafficking

Chargeable

• Those not considered ‘ordinarily resident’

• Visa over stayers• Refused asylum seekers• Irregular entrants• Tourists• Short-term visitors (including

British citizens residing abroad)

Secondary Care: Exemptions for Treatment

• Accident & Emergency • STIs (but NOT HIV)• Continuing course of

treatment • Sectioning under Mental

Health Act 1983• Treatment for prescribed

infectious illnesses e.g. TB

Secondary Care: Clinical Need?• Immediately necessary : if treatment not provided, will cause

serious permanent damage, must be provided

• Urgent : treatment which cannot wait until the person can be reasonably expected to return home (e.g. cancer), should be provided

• Non-urgent: Routine elective treatment, which could wait until the patient returned home, can be delayed

• Important to state if you believe the person needs immediately necessary or urgent treatment in your referral letter. You or your practice will not be charged for the care

How can you get involved?

Project:London

• Vulnerable migrants, homeless, sex workers

• Volunteer led walk-in clinic• Health advocacy, help with

accessing NHS• Help everyone regardless of

immigration status or where they live

• Bethnal Green, London• Volunteer GP• 1 afternoon a month for 6

months

http://www.medecinsdumonde.org.uk/projectlondon/volunteerhealthprofessionals.asp

recruitment@doctorsoftheworld.org.uk

Freedom From Torture

• Victims of Torture• Rehabilitation

– Counselling, group therapy• Medico-Legal Reports• Influencing others

– Policy, human rights, news media, campaigning

• Survivors voices

Other organisations

Case Report: HM

• 18yo Sierra Leone• Sent to UK via agent• “Work” for family• Raped by father of family• 30/40 pregnant• 8 GPs refused • Accepted by GP when term• Baby & mother registered

•Register vulnerable migrants

•Work with migrant health organisations