Mavin Kashyap is an ACF GP trainee at University of Bristol interested in health inequities and public health. He is on X:@MavinNathan
I recently had the privilege of shadowing a specialist community healthcare service for asylum seekers and refugee (ASR) adults and children who are accommodated in Home Office contingency accommodation. The service provides physical and mental health support, screening for relevant communicable diseases and catch-up vaccination programmes whilst concurrently helping people register with a local practice. Situated within an inner city GP surgery, it made me reflect on what transferrable lessons and principles can be applied to regular General Practice to ensure inclusive and high quality care for the populations they serve.
Getting it right first time
The “first impression” or “golden minute” can influence the direction of a meeting or consultation.
The “first impression” or “golden minute” can influence the direction of a meeting or consultation. So when thinking about primary care as one of the key ports of entry to the health system, its processes prior to even setting foot into a consulting room should be as streamlined as possible. This includes being aware of everyone’s right to free primary care and to register with a GP in the UK irrespective of immigration status. Yorkshire and Humber Public Health Network have collated numerous resources for health professionals around migrant health.1 I find this serves as a reminder to consider the unintended consequences of any change in organisational workflow, whether that is moving to digital triage or remote consultations.2 If it doesn’t work for our most vulnerable patients, it may not work for other cohorts of patients.
Time and health literacy
Routinely booking double appointments as the default setting for people where a translator is required should be the norm.
Most of the patients in clinic required the use of a translator, which increases the time taken to conduct a consultation. The BMA recommend 15 minute appointments to ensure clinical safety and quality, however I have heard colleagues state 10 minute appointments are still the default for all patients in their practices. If the average English speaking adult takes 11.9 minutes to discuss 2.5 problems,3 I’d struggle to see how I’d manage to do that with the aid of a translator even in a 15 minute appointment. Routinely booking double appointments as the default setting for people where a translator is required should be the norm.
Around half the population struggle with understanding health information4 and even within medicine, how we frame normal words like “positive” and “negative” can influence the interpretation of our message. This is perhaps best demonstrated in an American version of an office-based comedy show where one of characters receives a test result over the phone in front of his peers, to mixed reactions. Using all the tools we have as expert communicators in General Practice can help reduce uncertainty for our patients but requires time.
Agency and the wider determinants of health
The support that people seeking asylum receive from the Home Office is around £7 per day.
The support that people seeking asylum receive from the Home Office is around £7 per day.5 This made me reflect on how circumstances beyond our control can impact on health. Thinking about the wider determinants of health can be a useful framework for practising holistically to address unmet needs that lay outside healthcare services whilst being mindful of an individual’s level of agency so that we do more than signpost where appropriate. This highlights the value of social prescribing link workers who have up-to-date knowledge of community resources and VSCE organisations that can support people and communities. Alternatively, the Fairhealth website has resources amongst which is a table of “What every GP should know about local services…”6 which could act as a helpful induction exercise for new students, trainees or GPs in the practice.
My time in the ASR clinic felt incredibly relevant to regular General Practice and gave me an appreciation of the perspectives of healthcare from some of the most vulnerable in society. Through that lens we can help shape an inclusive general practice that is fit for all.
- Migrant Health: Resources, Tools and Guidance: Yorkshire and Humber Public Health Network;[Available from: https://yhphnetwork.co.uk/links-and-resources/coi/migrant-health/resources-tools-and-guidance/.
- Turner A, Morris R, Rakhra D, Stevenson F, McDonagh L, Hamilton F, et al. Unintended consequences of online consultations: a qualitative study in UK primary care. British Journal of General Practice. 2022;72(715):e128-e37. DOI: https://doi.org/10.3399/BJGP.2021.0720
- Chris S, Sunita P, Kate S, Leah B, Sarah P, Matthew R, et al. The content of general practice consultations: cross-sectional study based on video recordings. British Journal of General Practice. 2013;63(616):e751. DOI: https://doi.org/10.3399/bjgp13X674431
- Gursul D. NIHR Evidence: Health information: are you getting your message across? : NIHR; 2022 [Available from: https://evidence.nihr.ac.uk/collection/health-information-are-you-getting-your-message-across/.
- The truth about asylum: Refugee Council;[Available from: https://www.refugeecouncil.org.uk/information/refugee-asylum-facts/the-truth-about-asylum/.
- Teaching materials for primary care educators: fairhealth: Health Equity Action and Learning;[Available from: https://www.fairhealth.org.uk/empty.