By Kalina Shah

Many vulnerable migrants, including survivors of torture, trafficking, slavery, and abuse, find it impossible to access mainstream health services. Doctors of the World UK provides these excluded groups with support and treatment at our clinics in Bethnal Green and Brighton, as well as our pop-up clinics.

Everyone, regardless of their immigration status or income, is entitled to free primary healthcare such as initial GP and nurse consultations. Other services everyone can access for free include Accident & Emergency (A&E) treatment, the diagnosis and treatment of infectious and sexually transmitted diseases, family planning services, and the treatment of conditions caused by torture, domestic violence, trafficking or female genital mutilation.

But many excluded people, especially undocumented migrants (people without immigration papers), are wrongly turned away from GP practices as they are asked to provide documents they simply do not have - such as passports, driving licenses, utility bills or bank statements. Around four out of every five patients Doctors of the World sees at its London clinic are not able to register with the GP despite being fully entitled. This is despite clear NHS England guidelines stating that GP practices are not required to ask for proof of identification or address from patients wishing to register.

In short: GP practices should never refuse a patient who is not able to provide such documentation.

With regard to secondary healthcare, UK citizens and anyone who has been granted indefinite leave to remain are exempt from charges as are people who have an asylum claim in process (including appeals), and failed asylum seekers in receipt of section 95, section 4(2) or section 21 support. Many of our destitute patients do not fall under these categories and are presented with an extortionate bill by the hospital. If a bill in excess of £500 is not paid within two months, the hospital must inform the Home Office, the government department responsible for immigration.

This is why many of the people who come to Doctors of the World's clinics are reluctant to attend hospital appointments. This was certainly the case for Lucy*, 22, from China, who came to the clinic when she was three months pregnant and very unwell. She was too afraid to see a doctor and had to be sent to A&E. We helped Lucy register with a GP and receive antenatal care, but the bill she received from the hospital has caused Lucy a great deal of stress as she has no recourse to public funds and has a limited support network to help with the costs.

Sadly, the UK government has consulted on also charging overseas visitors and migrants for primary care services. Although the details of what the charges may entail are unclear, the proposals included charging for A&E, ambulance services, dental and ophthalmic services.

Extending charges will only further deter vulnerable groups from accessing vital health services and risks costing the NHS more by dissuading people from accessing healthcare quickly – for many health problems, the longer you leave them, the worse and more expensive to treat they become.

It is not yet clear what charges the Department of Health will introduce, but they are likely to have a huge impact on many already vulnerable people across the UK.

*Not her real name

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