Presentation given by Dr Shazia Munir on Friday 13th April 2012 to the 4th RCGP Junior International Committee Annual General Meeting in Croydon, London

1. “Think Global, Act Local”
Migrant Health in the UK
Dr Shazia Munir
13th April 2012, RCGP JIC AGM

2. “Think Global, Act Local”
Patrick Geddes, 1915
urges people to consider the health of
the entire planet and to take action in
their own communities and cities

3. • Salaried GP Elephant & Castle, London
• Beyond Europe Lead JIC
• Volunteer GP, Project:London, Doctors of the
World UK
• Medico-Legal Doctor, Freedom From Torture

5. Home or away?
• International work – barriers
• Preparation for overseas work
• “Think Global, Act Local”

6. Combining General Practice with International Work: Experiences of UK GPs, Chris Smith et al.

7. Migrant Health in the UK

8. Migrant Health in the UK
1. Migrant health needs
2. Who is entitled to NHS Primary Care?
3. Who is entitled to NHS Secondary Care?
4. How can you get involved?

10. • Refugee: a person who is
outside their country of
origin or habitual residence
because they have suffered
persecution on account of
race, religion, nationality,
political opinion, or because
they are a member of a
persecuted 'social group'
• Asylum seeker: a person who
is making a claim/request for
refugee status
• Refused asylum seeker
• Undocumented migrant

11. Migrant Health Needs
• Bread and butter GP
• Immunisations
• Communicable diseases: TB, HIV, Hepatitis B
and Hepatitis C
• Psychological needs: depression, PTSD
• Generally young & fit: 3 years in UK before
sought healthcare

12. Primary Care

13. Primary Care
• There are no regulations
regarding charging or
eligibility
• NHS (GMS Contract)
Regulations 2009, Schedule 6, Paragraph 17
“...general discretion to
register/refuse to register
anyone in catchment area,
so long as GP does not
discriminate...”

14. Primary Care: Other guidance
• The BMA’s General Practitioners’ Committee’s Guidance, which was
issued in Jan 2012 sets out the extent of the discretion that GP’s can
exercise.
• The General Medical Council’s Good Medical Practice makes clear that
the care of the patient should be the paramount consideration, not
whether they are an overseas visitor or not.
• The Royal College of GPs states: Based on the principle that General
Practitioners have a duty of care to all people seeking healthcare, the
RCGP believes that GPs should not be expected to police access to
healthcare and turn people away when they are at their most
vulnerable… In addition to failed asylum seekers, we would urge the
government to consider the health needs of other vulnerable migrant
groups, who we feel should also be entitled to free primary care.
Pending further legal clarification, the RCGP reminds all general
practitioners that failed asylum seekers are entitled to unrestricted
access to primary care services.

15. Primary Care
• So a GP can register
– ANYONE - AT GPs DISCRETION
– Refugees and asylum seekers
– Refused asylum seekers
– Overseas visitors
– Other undocumented migrants

16. Primary Care: Legal situation
• If a GP refuses to accept a person they are legally
obliged to provide emergency treatment
(immediately necessary) treatment for a maximum
of 14 days.
• PCTs are not allowed to challenge a GP’s decision to
register someone. If a PCT attempts to challenge a
GP’s decision this could then be legally challenged.

17. Secondary Care

18. Secondary Care
Entitled to free treatment Chargeable
• Asylum seekers • Those not considered
• Refugees ‘ordinarily resident’
• EEA nationals • Visa over stayers
• Dependency visa • Refused asylum seekers
• Work/ Student visas • Irregular entrants
• Those from countries with • Tourists
bilateral health agreements • Short-term visitors (including
• Victims of human trafficking British citizens residing
abroad)

19. Secondary Care:
Exemptions for Treatment
• Accident & Emergency
• STIs (but NOT HIV)
• Continuing course of
treatment
• Sectioning under Mental
Health Act 1983
• Treatment for prescribed
infectious illnesses e.g. TB

20. Secondary Care: Clinical Need?
• Immediately necessary : if treatment not provided, will cause
serious permanent damage, must be provided
• Urgent : treatment which cannot wait until the person can be
reasonably expected to return home (e.g. cancer), should be
provided
• Non-urgent: Routine elective treatment, which could wait
until the patient returned home, can be delayed
• Important to state if you believe the person needs
immediately necessary or urgent treatment in your referral
letter. You or your practice will not be charged for the care

21. How can you get involved?

22. Project:London
• Vulnerable migrants,
homeless, sex workers
• Volunteer led walk-in clinic
• Health advocacy, help with
accessing NHS
• Help everyone regardless of
immigration status or where
they live
• Bethnal Green, London
• Volunteer GP http://www.medecinsdumonde.org.uk/projectlo
• 1 afternoon a month for 6 recruitment@doctorsoftheworld.org.uk
months

23. Freedom From Torture
• Victims of Torture
• Rehabilitation
– Counselling, group therapy
• Medico-Legal Reports
• Influencing others
– Policy, human rights, news
media, campaigning
• Survivors voices

25. Other organisations

26. Case Report: HM
• 18yo Sierra Leone
• Sent to UK via agent
• “Work” for family
• Raped by father of family
• 30/40 pregnant
• 8 GPs refused
• Accepted by GP when term
• Baby & mother registered

27. •Register vulnerable migrants
•Work with migrant health organisations