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HPA calls for campaign for GPs to register migrants

A national campaign is needed to ensure that all migrants register with GP practices, concludes a Health Protection Agency (HPA) analysis that shows only a third register with a GP – far lower than official estimates.

Researchers looked at records for around 250,000 new entrants who arrived in the UK and found only 33% were registered with a GP at least nine months later.

These estimates are far lower than estimates published by the Office for National Statistics, which suggest a high level of registrations by migrants.

Worryingly, the researchers found a high proportion of more vulnerable patients who were likely to have complex health needs – the elderly and asylum seekers – were among those not registering with GPs.

The study comes after GP leaders criticised the population data used as the basis for list-cleansing regimes, which routinely target migrant populations to remove ‘ghost patients' from GP lists.

The HPA researchers looked at all patients screened for tuberculosis because they came from a high-risk country arriving at Gatwick or Heathrow airports between June 2009 and November 2010.

They then checked in August 2011 whether these patients were registered with a GP using the Personal Demographics Service. Only 33% had registered with a GP, with the least likely to sign up from the Americas, with only 16% found in GP records, and Africa, with a 24% registration rate.

Asylum seekers and their dependents, who made up a very small proportion of the migrants in the study at 1%, were also less likely to register, along with men and the over-65s.

The HPA researchers concluded in their report – published in BMJ Open this month – that specific measures to promote GP registration are needed, especially among the groups at highest risk.

They suggested this could include information packs when visas are issued, or from employers or at the border.

Study leader Dr Helen Stagg, from the HPA's respiratory department, said: ‘It is vital everyone has proper access to healthcare in order to ensure the wellbeing of the entire UK population.

‘This is particularly important for conditions where infection is easily transmitted and where a delay in care could lead to the need for more costly treatment.'

Migrant screening programmes and other awareness campaigns run by GPs may not be reaching the intended audience if patients are not even registering, she added.

Dr Sam Everington, a GP in east London and chair of Tower Hamlets CCG, said linguistic and cultural barriers and confusion over who was eligible for NHS care were leading to low levels of GP registration.

He said: ‘The whole system needs to be centralised. Anyone arriving in the country for more than six months should be issued with a card entitling them to NHS services at the point of arrival.

‘Having to turn up at a GP and show ID and proof of where you live is very difficult for some people, and that is equally true of people who move frequently.'

Professor Steve Field, chair of the National Health Inclusion Board, said migrant access was a major issue and he would be discussing the HPA findings at their next meeting.
He told Pulse: 'What we are looking at and what we have got to work out over the next few months is how we can make the NHS truely accessible to everyone.

'For migrants it is partly not knowing about what they are entitled to and information on how to access the NHS and understanding its values and the responsibilities of patients is really important.

'But the issue that keeps coming up when we are looking at vulnerable groups, be that migrants, asylum seekers, travellers or homeless people, is a constant theme or finding it very difficult to get accepted onto a practice list. I want to make sure there are no stumbling blocks to people accessing care.'

Dr Chaand Nagpaul, GPC negotiator and a GP in Stanmore, Middlesex, said: 'There is a consequence to GP practices of having high numbers of unregistered patients because they will end up having to be seen on an emergency basis for which the GP is not resourced.

'They will also end up using A&E and out of hours which will impact commissioning budgets. It is the responsibility of Government to make sure patients are registered with a GP. It is important from a public health point of view, making sure people have access to proper proactive healthcare. And important to ensure that general practice is properly resourced.'

For more information see the HPA's migrant guide

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