Patient data-sharing for immigration enforcement: a qualitative study of healthcare providers in England

Papageorgiou, Vasiliki; Wharton-Smith, Alexandra; Campos-Matos, Inês; Ward, Helen

doi:10.1136/bmjopen-2019-033202

Cited by 20 publications

(28 citation statements)

References 39 publications

(60 reference statements)

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“…Patients’ concerns about confidentiality and sharing personal information with non-clinical staff were found to be exacerbated by this consulting method. These fears may become even more of a barrier to access with vulnerable migrants who may have worries about data sharing and hence choose not to consult if asked personal questions at triage, especially by non-clinical staff 15 .…”

Section: Discussionmentioning

confidence: 99%

Does total triage and remote-by-default consulting impact vulnerable groups: A pilot study

Verity

Naidu

Brown

2020

Preprint

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BackgroundCOVID-19 mandated a rapid and dramatic transformation of general practice. ‘Total Triage’ (TT), where all consultations should be triaged first, and ‘Remote-by-Default’ (RbD) consulting, where a clinician should consult remotely unless there is a “clinical exception”, were advised. It is unclear how these new ways of working were implemented in practice, and how they impacted vulnerable patients.AimTo assess the impact of TT and RbD on vulnerable patients and identify mitigation strategies.Design and SettingA mixed methods service evaluation in Lewisham, London, an area of high deprivation.MethodThree parallel datasets were collected and analysed: Semi-structured interviews with stakeholders working with vulnerable groups and qualitative data from forums with black and ethnic minority patients, a survey of General Practitioners exploring implementation of TT and RbD, and a mystery shopper exercise reviewing access and messaging of ten practices.ResultsBarriers to access for vulnerable patients included challenges navigating the new model, difficulty engaging with remote consultations and digital exclusion. There was wide variation in messaging regarding changes to services and the practical application of TT and RbD. Potential solutions included clearer practice guidance and patient messaging, more consistent implementation, and identification and recording of patient access needs to enable better tailoring of care provision.ConclusionThis pilot study identified perceived and actual barriers to accessing general practice for vulnerable patients following the rapid introduction of TT and RbD consulting. It proposes immediate steps to mitigate some of these impacts and highlights the need for further research in this area.How This Fits InThe rapid and widespread adoption, recommended by NHS England, of total triage and remote-by-default consulting in general practice has yet to be evaluated. We provide a first look at how these changes are impacting those with historic difficulties in accessing primary care under the traditional GP model. We also provide some local recommendations that can be implemented easily at practice level and beyond, to mitigate the impact of these changes whilst making recommendations for further research to corroborate these findings widely.

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Section: Discussionmentioning

confidence: 99%

Does total triage and remote-by-default consulting impact vulnerable groups: A pilot study

Verity

Naidu

Brown

2020

Preprint

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“…A 2020 qualitative study exploring English healthcare providers’ perspectives on the impacts of data sharing for immigration enforcement reported concerns about impacts on health access, patient/clinician relationships, and about the interface between policy and their professional ethics, notably confidentiality and trust. 149 …”

Section: Discussionmentioning

confidence: 99%

“…A 2020 qualitative study exploring English healthcare providers' perspectives on the impacts of data sharing for immigration enforcement reported concerns about impacts on health access, patient/clinician relationships, and about the interface between policy and their professional ethics, notably confidentiality and trust. 149 The lack of (and need for) an evaluation of mandatory reporting has been commented on by other authors. 150 We have identified deficiencies in professional knowledge as an important contextual factor that can influence whether GPs talk about FGM.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

et al. 2021

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ObjectivesLittle is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.SettingPrimary care in England.Data sourcesRealist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.Primary outcome measureThis realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.Results124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.ConclusionsThere is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.PROSPERO registration numberCRD42018091996.

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“…However, of the 8900 patients who required identity checks in the pilot, only 50 were deemed ineligible for free NHS care (Lydall, 2019). These trials paved the way for the more recent policy of verifying proof of eligibility for NHS care, which is laden with issues including racial bias (Papageorgiou et al, 2020).…”

Section: Identification Checksmentioning

confidence: 99%

“…The breaches of patient confidentiality following the MoU agreement have left many vulnerable individuals fearful of facing immigration enforcement as a consequence of accessing healthcare. Subsequently, there have instances in which patients have withheld important details during consultations or provided false identification to clinicians, which may harm patient and public safety (Papageorgiou et al, 2020).…”

Section: Impact On Patientsmentioning

confidence: 99%

GP advocacy in supporting migrant access to NHS healthcare

2021

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Recent policy reform within the NHS poses significant challenges to accessing healthcare for migrants. This follows the introduction of upfront charging in healthcare services for those not ordinarily resident in the UK. The eligibility for free NHS care is currently determined by an individual’s immigration status. This has denied treatment to many of those who lack the relevant financial means, particularly the migrant population. Migrants are recognised to have various complex health needs and to experience a number of difficulties in accessing healthcare, from language barriers to navigating through an unfamiliar healthcare system. There is also concern that migrants may be deterred from engaging with healthcare services after certain policies have mandated NHS trusts to share confidential patient information with the Home Office. Restrictive NHS policies are likely to exacerbate existing barriers for access to healthcare, which could have a devastating impact on migrant health. Similarly, this may inadvertently widen health inequalities and increase the disease burden in society. GPs hold a valuable role, in which they can advocate on behalf of their patients. Advocacy support can empower migrants in making informed decisions and help to protect their rights in accessing healthcare. This article provides a concise overview of the wider impact of restrictive policies within the NHS, and supports GPs in advocating on behalf of migrants to improve their access to healthcare.

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Patient data-sharing for immigration enforcement: a qualitative study of healthcare providers in England

Cited by 20 publications

References 39 publications

Does total triage and remote-by-default consulting impact vulnerable groups: A pilot study

Does total triage and remote-by-default consulting impact vulnerable groups: A pilot study

Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

GP advocacy in supporting migrant access to NHS healthcare

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