3rd May 2019
Migrant Health – session by Dr Andrew Lephard, GP at Bevan Healthcare.
This week we had a session on Migrant Health by Andy Lephard, a senior GP at Bevan Healthcare who has been working in this sector for over 10 years and has often done teaching sessions on this subject due to his experience of this type of general practice.
Andy talked about the different ways that people can arrive in the UK – through refugee resettlement programmes, asylum seeking, being trafficked into the country. He told us about the asylum process and where patients tend to struggle – and why. They go through an initial interview, then later on a substantive interview which can last many hours. Then they receive a decision about their asylum application (it can take many months, although is only supposed to be a maximum of 6 months), and at that point they have 28 days to get themselves sorted with “normal” benefits and amenities (housing, universal credit, bank account etc) before their asylum support is stopped. Many people hit a crisis at this point as they may still not speak English and may have mental health problems, not know the area and not be in a good place psychologically or financially to get all these things sorted. Housing takes money and time – after living on asylum seeker benefits of £35 per week it is going to be quite hard to afford a deposit.
Asylum seekers are usually not allowed to work and are given approx. £35 per week to live with. Their accommodation and heating/bills are paid for but are often in areas of the country with low rents and the standard of accommodation is often low. They are moved around the country with little notice and have to sign in frequently at the home office so are not free to move around. During the process of travelling from their home country, many families are separated. Once someone has been accepted as refugee they have the right to family reunion (1st degree family members only and there are some stipulations) so many families might consider sending only one family member (paying to get across the world is expensive) and then reunite later. However also in other cases families may get shipped to different countries and some be claiming asylum in different parts of the world. Andy talked about the effects this has on people and the frustration and powerlessness that seems prevalent in many people stuck in this situation. The feeling that they have escaped the danger but life is harder than it used to be.
We learned about VPRS and GPP refugee resettlement schemes – a lot of people at Bevan have arrived through these means and they run new arrivals clinics for these people to discuss immunisations, general check ups and to introduce people to UK healthcare systems. These people do not have to go through the asylum system as they are already accepted as refugees. They are supported fully for a year after arrival and the difference in the way they are treated compared to asylum seekers who have arrived in the UK off their own back is quite huge.
People arriving on the VPRS (vulnerable person refugee scheme) will have come from UN refugee camps and be identified as particularly vulnerable – often with children who have serious health conditions that cannot be managed in a refugee camp. The GPP scheme is similar but is for any refugee from certain conflicts only, and they do not have to be particularly vulnerable. It does make the mind boggle a bit to wonder just how people would be chosen for these schemes, given the millions of people across the world still stuck in refugee camps.
After this session I felt that I understood these common migration methods much better and understood more about how healthcare needs to adapt to fit the difficulties that people in this situation can experience. Particularly mental health and orientation to the NHS. It stressed the importance of knowledge of charities that can help support people in need, and of non-medical support services (e.g. social prescribing) in helping new arrivals to integrate into their new local community.
Dr Helen Barclay