[The health of failed asylum seekers in UK; Are GP services appropriate for the health of failed asylum seekers in U.K.?]

By

Introduction

Over the last two decades, the health needs of refugees as well as asylum seekers have been well documented. Reports indicate difficulties in accessing health services, including registration with general practitioners (GPs) or lack of language support, and of particular needs, especially mental health as well as chronic illnesses, being inadequately met. From the viewpoint of healthcare providers, GPs report increased pressure of work resulting from patients who cannot speak English as well as who may manifest multiple problems, with health only representing part of the broader social problems. GPs and other health workers are often unsure about asylum seekers' entitlements to health, how to deal with asylum seekers' mental health problems and where to make appropriate referrals.

Discussion

At the same time, there is now a wide range of experience and expertise in providing health care for refugees as well as asylum seekers. New types of primary care services have been developed in dispersal areas and in other areas (primarily in London) where large numbers of asylum seekers as well as refugees are to be found. Several resource packs and other general and regional reports on service availability include descriptions of primary care interventions for refugees, drawing on local reports and self-description of services that give good accounts of service need and show very clearly how services are organized. Good clinical practice has been identified in a number of papers, as well as the crucial services that need to be available to meet the needs of refugees as well as asylum seekers, and there are also numerous guidelines and standards against which services can be judged.

However, there has been little systematic analysis and evaluation of the effectiveness of the interventions that have been developed to meet refugee and asylum seekers' needs. There is thus little evidence to guide primary care trusts (PCTs) and others in the development of new services. This paper suggests a simple framework that classifies the objectives of a range of service models, based on recognized health care needs of refugees and asylum seekers. It is hoped that setting out clear objectives for services will facilitate comparison between different service models, and could assist PCTs to plan services for this group on the basis of clearer evidence. The framework distinguishes three different but complementary objectives of primary care services for refugees and asylum seekers: enabling access, comprehensive provision, and essential support services.

Methods

The paper draws on a review of information on primary health provision for this group from published and 'grey' literature on the health needs and primary care services for refugees and asylum seekers. The full review of which can be found in the author's report for the Hounslow Primary Care Trust. Material was accessed through online and library literature searches, and by a request for information to chief executives of National Health Service (NHS) trusts in England and to directors of social services in urban local ...