Explain The Barriers That Influence Patient Access And Uptake
Discuss the barriers that may influence patient access and uptake of community health services
The Institute of Rural Health (2005) notes that the majority of healthcare that patients receive is delivered in a primary or community care setting. For this reason, it is important that patients have access to general practitioner (GP) practices and primary care centres. Access to health care is concerned with the relationship between need, provision and utilisation of health services (NCCSDO, 2001).
Using health services require substantial effort on the part of people. People have to call up a range of resources, including knowledge and information resources, social, language and support resources, and practical resources (NCCSDO, 2001). There is evidence that refugees and asylum seekers may be disadvantaged in their access to these resources (Burchill, 2001). Eke, 2006 points out that thousands come the UK each year, having to adjust to a new life in foreign country and not knowing where to start.
People’s interpersonal and language skills, and in particular their ability to articulate their health problem and conduct consultations, may mediate access to care (NCCSDO, 2001). Asylum seekers are often from very different cultures, may not speak …show more content…
English, may have complex healthcare requirements and may not understand the principles behind the UK health system (Department of Health (DOH), no date).
The Department of Health (DOH, 2003) outlines that like other UK residents, persons with an outstanding application for refuge in the UK are entitled to use NHS services without charge. However, the NCCSDO (2001) indicates that while free access to a GP is every asylum seeker 's right, not all primary care staff know this and this setting might not be the most appropriate starting point for someone arriving with no knowledge of English, or no conceptual understanding of the UK health service.
Burnett & Fassil (2002) (in Heptinstall et al, 2004) concur that refugees and asylum seekers have reported difficulties dealing with frontline staff, such as surgery receptionists. Studies conducted by Grant and Deane (1995), Karmi (1998) and Holman et al (2000) (in Heptinstall et al, 2004) demonstrate a lack of awareness among healthcare workers, including primary care practitioners, of the healthcare needs of asylum seekers and refugees and their entitlement to services. General practices often feel overwhelmed by the time-consuming nature of an asylum family 's needs (Heptinstall et al, 2004).
Sales, 2001 notes that the extra resources that may be required to effectively meet the healthcare requirements of asylum seekers and refugees may create aggravating, discrimination and alienation with members of the host population. Heptinstall et al (2004) assert that even service providers like nurses and social workers, who perceive their own services being cut back, can be resentful.
Johnson (2003) informs that healthcare providers report direct and indirect costs relating to the treatment of asylum seekers including costs associated with language support.
Regarding indirect costs, GPs report that asylum seekers affect target payments where those registered on patient lists refuse or do not turn up for vaccinations and cervical screening. As a result of these real or perceived costs, some healthcare providers are reluctant to register asylum seekers. A number of health authorities and primary care trusts have recognised this is a problem and are starting to offer raised payments for the registration of asylum seekers. Others are funding additional support staff for practices (Johnson,
2003).
People of minority ethnicity may become alienated from organisations that appear to stereotype them or treat them with a lack of sensitivity (NCCSDO, 2001). Integral to access for these individuals are interpreting services, cultural sensitivity and attention to health problems that may require non-western approaches to care and treatment (Heptinstall et al, 2004). The language used in regards to refugee and asylum issues is invariably negative. Common terms used are 'flooding ', 'swamping ', overrunning ', 'illegal ', 'burden ' and 'disaster ' (Refugee Council 2004 in Heptinstall et al, 2004). Such language serves to underpin prejudices. For these individuals, concerns about eligibility for services or discrimination of service providers can negatively influence their uptake of services (NCCSDO, 2001).
Cultural dissonance i.e. discord between the cultural norms of health care organisations and their imagined ideal user, can create a barrier to access (NCCSDO, 2001). For example research found that many preferred ‘Walk-in’ systems over booked appointment systems. Also, although information about health services needs to be in relevant languages, not all refugees are literate, particularly women. Somali culture, for instance, focuses more on oral communication ( Burnett and Peel, 2001).
Psychosocial factors, cultural and health beliefs can negatively affect individuals’ uptake of community health services (NCCSDO, 2001). For asylum seekers, other pressing needs may leave health low on their personal priority list. Their cultural and health beliefs can result in lack of contact with primary health services, for example, disregard of signs and symptoms of underlying disease due to the belief that they are inconsequential, or use of traditional remedies to deal with such symptoms as well as fears of stigma associated with medical diagnosis. NCCSDO (2001) advise that information resources about illness should be available in forms that people can find and use readily, but it should be accepted that such interventions are likely to have only limited impact in altering help-seeking behaviour, and only then for specified conditions.
The Department of Health has prepared a fact sheet to explain the role of UK health services, the National Health Service (NHS), to newly-arrived individuals seeking asylum. It covers issues such as the role of GPs, their function as gatekeepers to the health services, how to register and how to access emergency services. The leaflet has been translated into forty languages, and is only available electronically, for printing when needed (DOH, no date) (see Appendix ).
The Department of Health’s Asylum Seeker Co-ordination Team (ASCT) co-ordinates healthcare policy for asylum seekers and refugees. The team works across the Department of Health and other Government departments, and with health workers and service planners in the field. ASCT liaises with the Home Office to ensure that health and social care requirements are met at all stages of the asylum process, and taken into account in policy planning (DOH, no date).
REFERENCES
Burchill, J. (2001) Access to services for refugees. Professional Nurse. 17, 4, pp. 214-215.
Burnett, A., and Peel, M. (2001) Asylum seekers and refugees in Britain, British Medical Journal, 322(7285) pp. 544-547.
Department of Health (no date) Asylum seekers and refugees [online] [accessed May 6, 2006] Available from:
<http://www.dh.gov.uk/PolicyAndGuidance/International/AsylumSeekersAndRefugees/fs/en>.
Department of Health (2003) Caring for dispersed asylum seekers: a resource pack. [online], [accessed: May 6, 2006], available from: <www.doh.gov.uk/ asylumseekers/resourcepack.pdf.>.
Eke, C. (2006) Asylum seekers and refugees are to receive important healthcare help. Black Britain, [online] dated: January 17, 2006 [accessed May 5, 2006] Available from:
<http://www.blackbritain.co.uk/news/details.aspx?i=1939&c=uk>.
Heptinstall, T., Kralj, L. and Lee, G. (2004) Asylum seekers: a health professional perspective. Nursing Standard. 18(25), pp. 44 – 56.
Johnson, M. (2003) Asylum seekers in dispersal - healthcare issues – Home Office online report 13/03 [online] London: Research Development and Statistics Directorate, Home Office, [accessed May 7, 2006] Available from: <http://www.homeoffice.gov.uk/rds/pdfs2/rdsolr1303.pdf>
Institute of Rural Health (2005) Rural proofing for health: a toolkit for primary care organisations [online] accessed May 6, 2006, available at: <http://www.ruralhealthgoodpractice.org.uk/index.php?page_name=section2_chapter3_primary_care>.
National Co-ordinating Centre for NHS Service Delivery and Organisation (NCCSDO) (2001) Access to health care: report of a scoping exercise [online] [accessed April 18, 2006] Available from: <http://www.sdo.lshtm.ac.uk/pdf/accessscopingexercise_report.pdf>.
Sales, R. (2002) The deserving and the undeserving? refugees, asylum seekers and welfare in Britain. Critical Social Policy. 22(3), pp. 456-478.
The Institute of Rural Health (2005) notes that the majority of healthcare that patients receive is delivered in a primary or community care setting. For this reason, it is important that patients have access to general practitioner (GP) practices and primary care centres. Access to health care is concerned with the relationship between need, provision and utilisation of health services (NCCSDO, 2001).
Using health services require substantial effort on the part of people. People have to call up a range of resources, including knowledge and information resources, social, language and support resources, and practical resources (NCCSDO, 2001). There is evidence that refugees and asylum seekers may be disadvantaged in their access to these resources (Burchill, 2001). Eke, 2006 points out that thousands come the UK each year, having to adjust to a new life in foreign country and not knowing where to start.
People’s interpersonal and language skills, and in particular their ability to articulate their health problem and conduct consultations, may mediate access to care (NCCSDO, 2001). Asylum seekers are often from very different cultures, may not speak …show more content…
English, may have complex healthcare requirements and may not understand the principles behind the UK health system (Department of Health (DOH), no date).
The Department of Health (DOH, 2003) outlines that like other UK residents, persons with an outstanding application for refuge in the UK are entitled to use NHS services without charge. However, the NCCSDO (2001) indicates that while free access to a GP is every asylum seeker 's right, not all primary care staff know this and this setting might not be the most appropriate starting point for someone arriving with no knowledge of English, or no conceptual understanding of the UK health service.
Burnett & Fassil (2002) (in Heptinstall et al, 2004) concur that refugees and asylum seekers have reported difficulties dealing with frontline staff, such as surgery receptionists. Studies conducted by Grant and Deane (1995), Karmi (1998) and Holman et al (2000) (in Heptinstall et al, 2004) demonstrate a lack of awareness among healthcare workers, including primary care practitioners, of the healthcare needs of asylum seekers and refugees and their entitlement to services. General practices often feel overwhelmed by the time-consuming nature of an asylum family 's needs (Heptinstall et al, 2004).
Sales, 2001 notes that the extra resources that may be required to effectively meet the healthcare requirements of asylum seekers and refugees may create aggravating, discrimination and alienation with members of the host population. Heptinstall et al (2004) assert that even service providers like nurses and social workers, who perceive their own services being cut back, can be resentful.
Johnson (2003) informs that healthcare providers report direct and indirect costs relating to the treatment of asylum seekers including costs associated with language support.
Regarding indirect costs, GPs report that asylum seekers affect target payments where those registered on patient lists refuse or do not turn up for vaccinations and cervical screening. As a result of these real or perceived costs, some healthcare providers are reluctant to register asylum seekers. A number of health authorities and primary care trusts have recognised this is a problem and are starting to offer raised payments for the registration of asylum seekers. Others are funding additional support staff for practices (Johnson,
2003).
People of minority ethnicity may become alienated from organisations that appear to stereotype them or treat them with a lack of sensitivity (NCCSDO, 2001). Integral to access for these individuals are interpreting services, cultural sensitivity and attention to health problems that may require non-western approaches to care and treatment (Heptinstall et al, 2004). The language used in regards to refugee and asylum issues is invariably negative. Common terms used are 'flooding ', 'swamping ', overrunning ', 'illegal ', 'burden ' and 'disaster ' (Refugee Council 2004 in Heptinstall et al, 2004). Such language serves to underpin prejudices. For these individuals, concerns about eligibility for services or discrimination of service providers can negatively influence their uptake of services (NCCSDO, 2001).
Cultural dissonance i.e. discord between the cultural norms of health care organisations and their imagined ideal user, can create a barrier to access (NCCSDO, 2001). For example research found that many preferred ‘Walk-in’ systems over booked appointment systems. Also, although information about health services needs to be in relevant languages, not all refugees are literate, particularly women. Somali culture, for instance, focuses more on oral communication ( Burnett and Peel, 2001).
Psychosocial factors, cultural and health beliefs can negatively affect individuals’ uptake of community health services (NCCSDO, 2001). For asylum seekers, other pressing needs may leave health low on their personal priority list. Their cultural and health beliefs can result in lack of contact with primary health services, for example, disregard of signs and symptoms of underlying disease due to the belief that they are inconsequential, or use of traditional remedies to deal with such symptoms as well as fears of stigma associated with medical diagnosis. NCCSDO (2001) advise that information resources about illness should be available in forms that people can find and use readily, but it should be accepted that such interventions are likely to have only limited impact in altering help-seeking behaviour, and only then for specified conditions.
The Department of Health has prepared a fact sheet to explain the role of UK health services, the National Health Service (NHS), to newly-arrived individuals seeking asylum. It covers issues such as the role of GPs, their function as gatekeepers to the health services, how to register and how to access emergency services. The leaflet has been translated into forty languages, and is only available electronically, for printing when needed (DOH, no date) (see Appendix ).
The Department of Health’s Asylum Seeker Co-ordination Team (ASCT) co-ordinates healthcare policy for asylum seekers and refugees. The team works across the Department of Health and other Government departments, and with health workers and service planners in the field. ASCT liaises with the Home Office to ensure that health and social care requirements are met at all stages of the asylum process, and taken into account in policy planning (DOH, no date).
REFERENCES
Burchill, J. (2001) Access to services for refugees. Professional Nurse. 17, 4, pp. 214-215.
Burnett, A., and Peel, M. (2001) Asylum seekers and refugees in Britain, British Medical Journal, 322(7285) pp. 544-547.
Department of Health (no date) Asylum seekers and refugees [online] [accessed May 6, 2006] Available from:
<http://www.dh.gov.uk/PolicyAndGuidance/International/AsylumSeekersAndRefugees/fs/en>.
Department of Health (2003) Caring for dispersed asylum seekers: a resource pack. [online], [accessed: May 6, 2006], available from: <www.doh.gov.uk/ asylumseekers/resourcepack.pdf.>.
Eke, C. (2006) Asylum seekers and refugees are to receive important healthcare help. Black Britain, [online] dated: January 17, 2006 [accessed May 5, 2006] Available from:
<http://www.blackbritain.co.uk/news/details.aspx?i=1939&c=uk>.
Heptinstall, T., Kralj, L. and Lee, G. (2004) Asylum seekers: a health professional perspective. Nursing Standard. 18(25), pp. 44 – 56.
Johnson, M. (2003) Asylum seekers in dispersal - healthcare issues – Home Office online report 13/03 [online] London: Research Development and Statistics Directorate, Home Office, [accessed May 7, 2006] Available from: <http://www.homeoffice.gov.uk/rds/pdfs2/rdsolr1303.pdf>
Institute of Rural Health (2005) Rural proofing for health: a toolkit for primary care organisations [online] accessed May 6, 2006, available at: <http://www.ruralhealthgoodpractice.org.uk/index.php?page_name=section2_chapter3_primary_care>.
National Co-ordinating Centre for NHS Service Delivery and Organisation (NCCSDO) (2001) Access to health care: report of a scoping exercise [online] [accessed April 18, 2006] Available from: <http://www.sdo.lshtm.ac.uk/pdf/accessscopingexercise_report.pdf>.
Sales, R. (2002) The deserving and the undeserving? refugees, asylum seekers and welfare in Britain. Critical Social Policy. 22(3), pp. 456-478.