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When the call came to provide a warm welcome to refugees from Afghanistan, to support families who had fled their homes under extreme circumstances, health and social care services in East Devon banded together. Victoria Vaughan reports
Dr Barry Coakley was having lunch at his desk one Friday in early September when he received an email from Devon CCG announcing that the Home Office was placing 60 refugees from Afghanistan in Exmouth, Devon at 3pm that afternoon and he, as clinical director (CD) of the local PCN, was charged with creating a health record for them.
The terrors of the swift resurgence of the Taliban following the US withdrawal from Afghanistan were, for the majority of us, confined to news reports. But for one East Devon PCN it became a matter of urgent and immediate work.
As CD of Woodbury, Exmouth and Budleigh (WEB) PCN, Dr Coakley immediately put out the call for help to the seven practices in the area. The reply was just as swift: ‘Sure, what do you need?’
There was no prior information about the refugees because they fled their homes in such haste – arriving in just the clothes they stood in. They left loved ones behind. Daily medication and glasses were not even an afterthought.
‘They arrived with very little in the way of belongings. Our role was to provide them with all the things we take for granted,’ says Dr Coakley, who worked in collaboration with Devon County Council, Devon CCG and a number of health and social care agencies to support the refugees.
A total of 12 families arrived by coach in the seaside town of Exmouth with 40 children between them, ranging in age from nine months to 18 years. They have been given accommodation in a coastal hotel until more permanent housing can be found – and this could be anywhere in the country.
Although all the PCN’s practices offered to help, the location meant it made sense for the four Exmouth practices to take on the patients. The two larger practices took 20 patients each and the smaller two took 10.
Addressing language issues
The families were also divided by language groups. Although each family has an English speaker – which is why they have safe harbour here, because they were helping the UK Forces in Afghanistan – there are four different dialects among the other family members. Translators, of which there were few – were found and Language Line has been used during follow-up appointments.
The practice teams of GPs, practice nurses, advanced nurse practitioners, healthcare assistants, practice managers and administration staff worked to establish consultation rooms in the hotel. After three days, all the patients had been seen and a health record for each had been built.
‘It became clear that each patient needed an NHS number. This unlocks the rest of the system,’ says Dr Coakley, who is now sharing what he’s learnt with Exeter City PCN as more refugees are due to arrive there. ’We’ve fed back that filling in the registration forms to get this number should be started as soon as the people get off the plane.’
‘We started by seeing family groups together as it seemed to be the most time-efficient way of doing things. However we’ve learned, both from the families and the interpreters who were native Afghans, that culturally the entire family likes to stay strong for each other rather than to discuss any concerns. This made the process of gathering the necessary history challenging. In hindsight, seeing patients individually might have made more sense and saved time in the end.
‘If we had more time, I would recommend initially just chatting to the patients. Knocking on the door and saying “Hi, I’m the local doctor, how can I help?” and having that initial conversation is the best way to start the caring relationship and I think we would have saved time later if we could have done this first,’ says Dr Coakley.
What the team didn’t expect was the initial euphoria of the refugees. ‘The outpouring of gratitude from the families for their safety meant that conversations about healthcare were low on the list of priorities when their lives and those of their children had likely been saved,’ says Dr Coakley, who is visibly moved by his new patients . He says he – and his whole team – have ‘taken them to their hearts’.
Although the families are generally in good health, there were a number of challenges for the PCN team. The children’s immunisations had to be started and brought into line with the NHS vaccine programme. People’s regular medication needs had to be determined.
‘It seems while initial diagnosis of a problem may have happened, the ongoing management hasn’t so much. Dentistry is another area they need help with as dental pain is just something they live with. So we worked with local services to ensure they were added to the waiting list, but access to NHS dentistry is a challenge in this area for everyone.
‘Sometimes we’d be struggling to deduce the cause of headaches and blurred vision only to discover, with further questioning, that the patient wears glasses – which have been left behind,’ says Dr Coakley. And this gives rise to another challenge – navigating the healthcare system.
‘We’ve had to explain a lot about our healthcare system; how you go from a GP to a specialist at a hospital. You can give someone a prescription and it means absolutely nothing. You have to show them where to take it and how to get medication. The health system can be complicated enough for people that have lived here all their lives,’ says Dr Coakley.
Now, after the initial euphoria, the refugees are starting to process their circumstances, what they have been through and the fact that they have left loved ones behind – grown-up children in some cases.
‘Things start to come to the surface,’ says Dr Coakley. He is supported by the local mental health teams, who help these patients as needed. This is new territory for the team.
‘We’ve treated people for PTSD before,’ he says. ‘Lympstone Commando – the Royal Marine training centre – is just up the road and we have many ex-servicemen and women in our community. However, these people are civilians. We haven’t had any specific training in how to deal with the trauma that refugees might have experienced, but we have been supported by Devon County Council and our mental health teams. The Refugee Council also offered support and guidance,’ he says.
Dr Coakley is adamant that the PCN structure has been invaluable in enabling him to co-ordinate effective care for the families.
‘It’s been a team effort and we’ve been there to support each other as we have been at the height of the pandemic. Having a PCN meant that there was a single point of contact for Devon CCG, the Home Office and the county council and locally those relationships were in place so that people were ready and willing to help and work together to support these families.’
Of course this kind of work costs. Extra funding was given to Devon by the Home Office as part of the Afghan Relocations and Assistance Policy (ARAP), which made £3m of additional NHS funding available so that Afghans arriving under the scheme can access healthcare and register with a GP.
Exmouth is not the final destination for these families. They are on the waiting list for council housing which, when it becomes available, could be anywhere in the UK.
A home office spokesman said: ‘We do not want to see families remain in hotel accommodation for prolonged periods, and there is a huge effort under way to get families into permanent homes so they can settle and rebuild their lives.’
When they are moved, Dr Coakley will endeavour to communicate a handover with the new PCNs.
However, as the time frame for this is unknown, thoughts are turning to getting the children into education to give them a purpose, friends and a future.
‘The teenagers in particular want to get back into education. They want to learn the language and start planning their futures here. Even though it’s temporary, we’re looking at getting the children into the schools which would be great for them and for the area.’
Clinical director: Dr Barry Coakley
Practice: Claremont, Exmouth, Devon
PCN: Woodbury, Exmouth and Budleigh (WEB)
Location: South East Devon
Number of practices in PCN: 7
Number of patients in PCN: 52,000
PCN hires through additional roles reimbursement scheme (ARRS): three clinical pharmacists, first contact physios (linked with Royal Devon & Exeter NHS Foundation Trust), occupational therapist, young people’s mental healthcare co-ordinator, two health coaches and mental health link worker.
Recruiting (ARRS roles still to fill): Band 6 occupational therapist, frailty care co-ordinator, dietitian
Tips from the WEB PCN experience of receiving refugees