GPs need training and funding in caring for refugees and asylum seekers

Editor—UK asylum seekers and refugees have the same rights to health care as the settled population. None the less, refugees report difficulties accessing health care—for example, in registering with a general practitioner.¹ They are also sometimes registered as temporary residents, which is detrimental for continuity of care.²

We sent a postal questionnaire to all 129 general practitioners in Lothian, an area in Scotland with an estimated 3000 refugees. It focused on the need for extra funding for general practices with refugees, the best place for providing primary care services, and the need for training.

Ninety five responses were received (a response rate of 73.6%). The table summarises the results (see bmj.com for more details).³

Table 1.

British general practitioners' experiences, training, behaviour, and views on aspects of care for refugees and asylum seekers

Question	No of respondents	Answer	No (%) giving answer
Do you have any experience of treating asylum seekers or refugees?	94	Yes	33 (35)
Have you undergone special training to care for asylum seekers and refugees?	95	Yes	13 (14)
Does your practice staff undergo any training to care for asylum seekers and refugees?	94	Yes	4 (4)
Do asylum seekers and refugees have the same rights for provision of NHS treatment?	93	Different rights	10 (11)
		Don't know	22 (24)
Do asylum seekers and refugees have to pay for NHS treatment?	94	Yes	4 (4)
		Don't know	15 (16)
Are asylum seekers and refugees registered as temporary or permanent residents?	44*	As temporary residents	6 (14)
Do you require asylum seekers or refugees to produce any proof of identity for registration?	68*	Yes	8 (12)
Where do you feel that asylum seekers and refugees should be given primary care services?	86	GP	42 (49)
		Specialist GP	23 (27)
		Multidisciplinary centre	16 (19)
		Other	5 (5.8)
Do you think that general practitioners should get additional funding if they have a high caseload of refugees and asylum seekers?	94	Yes	87 (93)

GP=general practitioner.

^*Many non-respondents cited lack of experience with refugees as a reason for not answering.

About one third of general practitioners had treated refugees, but few staff had undergone training. Of 82 general practitioners (86%) who had not received training, 17 (21%) wanted training. Nearly one fifth were unsure or incorrect about refugees' entitlement to free NHS treatment. Respondents were divided on whether refugees should be treated at normal practices or by specialist services. Most general practitioners thought that practices with a high caseload of refugees should receive additional funding. Thirty one general practitioners' suggestions on funding per refugee ranged from £20-£1000, with a mean of £131 and a median of £100.

General practitioners supported extra funding and suggested about £100 per refugee; many favoured treating refugees in normal practices, but many had no relevant training. Some were unaware of refugees' NHS entitlements, as has been previously reported.⁴ To our knowledge, these are the first published data on the views of general practitioners (or their international equivalent) on funding, training, and the place of care for refugee primary healthcare. A need exists to develop approaches to health care in urban centres with varying numbers of refugees.