Abstract
BackgroundCOVID-19 has led to big changes in UK primary care, including rapid digitalisation, with unknown impact on migrant groups.AimTo understand the pandemic’s impact on recently-arrived migrants and their access to primary health care, and implications for vaccine roll-out.Design and settingQualitative study involving semi-structured interviews with primary care professionals (PCPs) and migrants in urban, suburban, and rural settings across England.MethodSixty-four PCPs and administrative staff, and 17 recently-arrived migrants were recruited using purposive, convenience, and snowball sampling. In-depth, semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis.ResultsPCPs and migrants concurred that digitalisation and virtual consultations have amplified existing inequalities in access to health care for many migrants, due to a lack of digital literacy and access to technology, compounded by language barriers. PCPs were concerned that virtual consultations resulted in difficulties building trust and risked missing safeguarding cues. Both PCPs and migrants highlighted challenges around registering and accessing health care due to physical closure of surgeries, as well as indirect discrimination, language and communication barriers, and a lack of access to targeted and tailored COVID-19 information or interventions. Migrants reported a range of specific beliefs, from acceptance to mistrust, around COVID-19 and potential COVID-19 vaccines, often influenced by misinformation. Innovative opportunities were suggested, including translated digital health advice using text templates and YouTube; these merit further exploration.ConclusionPandemic-related changes to primary care delivery may become permanent; some migrant groups are at risk of digital exclusion and may need targeted additional support to access services. Solutions are needed to address vaccine hesitancy in marginalised groups to ensure equitable COVID-19 vaccine uptake.
Highlights
Migrants to the UK — recent arrivals and marginalised groups, including refugees and asylum seekers — may face barriers to accessing primary care.[1]
Pandemic-related changes to primary care delivery may become permanent; some migrant groups are at risk of digital exclusion and may need targeted additional support to access services
48 interviews were held with primary care professionals, — namely, 25 GPs, 15 practice nurses (PNs), seven healthcare assistants (HCAs), and one clinical pharmacist
Summary
Migrants to the UK — recent arrivals and marginalised groups, including refugees and asylum seekers — may face barriers to accessing primary care.[1]. The digitalisation of primary care has been a key feature of the pandemic, with countries moving from face-to-face to virtual consultations — that take place via telephone, video, and online form-based communications (including eConsult) — and text communications (including accuRx).[7,8] A longitudinal mixed-methods study on the implementation of remote consulting in UK general practice demonstrated a rapid change: 90% of GP appointments and 46% for nurse appointments were held remotely in April 2020 in the 21 practices studied.[9] Text messaging increased more than threefold in April to July 2020 compared to 2019.9 Digitalisation, can disproportionately disadvantage marginalised groups, amplifying existing structural inequalities through differential access and digital literacy, differential capacity to benefit, and differential motivation for use.[10,11] A recent report on migrants living in vulnerable circumstances in England described an inability to register with a GP, digital exclusion, and language barriers as preventing access to health advice for those with COVID-19 symptoms.[12] These barriers may have important implications for the COVID-19 vaccine roll-out, with Public Health England suggesting flexible delivery models to reduce inequalities in vaccine uptake in at-risk populations from Black, Asian, and minority ethnic groups,[13] which includes some migrant populations. 19 has led to big changes in UK primary care, including rapid digitalisation, with unknown impact on migrant groups
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