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How we cope with a high proportion of non-English-speaking patients

Staff at a south London practice have a high proportion of transient patients, many of whom don’t speak English. Here’s how they cope.

What is your patient population like?

We have over 11,000 patients, around 10% of whom don’t speak English as a first language. We’re in a highly populated, highly deprived area of south east London, which seems to be the first stopping place for people coming from all over the world. It used to be mainly people from African countries but in the last couple of years we’ve noticed an increase in people coming from South America who originally came into Spain and have made their way up through northern Europe into the UK. We’ve also just started to see what we think is the first trickle of what I call ‘war refugees’, for example people from Afghanistan.

Additionally, our transient population normally stays between one and two years so we are dealing with a very high turnover of about 10% a year. This makes the practice extra busy with all the administration this involves.

How do you ensure patients who don’t speak English get the care they need?

The first problem is when patients who don’t speak English come in and try to register at the practice. It’s especially difficult explaining to someone who doesn’t speak English why we need to know where they live. Normally, they bring a friend or someone they know to come in and help them, or sometimes we ask them to get a colleague or a friend on the phone to act as intermediary. We’re fortunate enough to have a Spanish speaking member of staff, and often there is a patient in the reception area who speaks Spanish, who can help us communicate with patients.

We tell them to book a doctor’s appointment and health check at a time when we can organise an interpreter.

Secondly, the interpreting services we use are funded by the CCG but are under real strain in London at the moment. Each appointment with the interpreter is double length, as the interpreter makes the consultation a lot slower. Last week, we had 23 patients requiring interpreting services - 46 slots. We have to book these about a week in advance, although sometimes people have to wait around two weeks, especially for a Spanish interpreter because this service is in such great demand.

We’re also having a number of documents translated this year into Spanish and one African main language at the moment. Because this is expensive, we don’t translate the registration document or correspondence we send to patients, just notices about appointment services and the latest newsletters that come out once or twice a year and we can display in the practice.

What are the challenges from cultural differences?

There have been a couple of cases where patients think we’re being disrespectful to an elderly member of their family – we’re treating them exactly the same, but there may be different cultural expectations.

What tips would you have for other practices with a high proportion of non-English speakers?

Try and get some multilingual staff by hook or by crook. Also, have a good system so that your staff knows how to use the interpreting service, and can get the message across to patients that they cannot see a doctor until we have an interpreter for them.

One further challenge is that we’ve noticed a number of health tourists that come over here with secondary care issues which need to be referred onwards. We refer them on, they register as temporary patients and when we chase them up to make them permanent (as obviously we don’t get paid for temporary patients) some will tell you that they’re back off to their country. In one case the woman said it’s too expensive so she’s going back to South America. Over a year, there must be a dozen of those people.

Christian Jennings is practice and business manager and Sue White is patient services manager in Camberwell Green surgery, south London

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Readers' comments (9)

  • The health tourism is a big issue in Tottenham. There are a growing number of Eastern European ladies that head over 22-26 weeks pregnant claiming to have no antenatal care back home but state they want antenatal care in London, plan to deliver their babies here and then are due to head back home with baby. Ethically a very unusual situation.

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  • Give free booze to people and they will get wasted. Charge a pound and they will drive home. Win win.

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  • The issue of interpreters is a minefield for 3 reasons... Using other patients could put you in breach of confidentiality. Using a relative in some cultures might result in you getting what the relative wants you to be told rather than what the patient said if what is being consulted about happens to be a problem for them. Finally the professional interpreters should be translating accurately but others might not. On top of all of this it is another hidden cost for the NHS.

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  • Why do we have to pay for translators? Either they learn English, bring a relative or pay for a translator.
    Anyway, how come they get double time?

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  • We too havea huge number of patients whose first language is not English. But there again we are in Wales....

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  • We have a Russian-speaking Principal GP, HCA, and PM (myself) - all native Russian-speakers.

    This has resulted in a very difficult scenario of many (too many) eastern europeans flocking to our surgery via word-of-mouth and has put a tremendous ammount of pressure on the team as every Tom, Dick and Harry, or rather Ivan, Sergei and Vladimir turning up at a reception desk expecting for somebody to materialise out of thin air to translate for the most basic of queries.

    Fair enough, we do save a fair bit of cash for the local CCG on interpreting services, but the rest of the team is really struggling with a huge variety of situations and is resulting in a double waiting time for the appointment with the Principal GP as opposed to other clinicians.

    My best bit of advice is NOT to advertise your clinicians second/third/fourth languages, limit practice staff interaction to English only and let the CCG/patient/local authority pick up the interpreter bill.

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  • i had foreign patient. i asked simple question if she has headache. interpreter took 2 minutes of talk . answer was "no". translators are paid by minutes i was told . they doi want to sort out all their 30 years problems in 10 minutes. i think we should be paid £50+ for these consultation which are lengthy. i must say social services encourage them to be off sick.

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  • In this country we speak english.
    If you wish to speak a different language go to the appropriate country.
    That is what freedom is all about

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  • We use ' language line' telephone tanslation service, is quick and efficient and instant service when we need it and any language. I'd recommend it.

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