Perspectives on registration to primary care from inclusion health groups in England: a mixed-method study

Ada Humphrey; Lucy Fagan; Elspeth Carruthers; Jin-Min Yuan; Kemi Ogunlana; Janet Alfred; Ahimza Nagasivam; Kerrie Stevenson; Robert W Aldridge; Fiona Stevenson; Sitira Williams; Rachel Burns

doi:10.1016/S0140-6736(23)02074-3

Perspectives on registration to primary care from inclusion health groups in England: a mixed-method study

Lancet. 2023 Nov:402 Suppl 1:S53. doi: 10.1016/S0140-6736(23)02074-3.

Authors

Affiliations

¹ Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; London School of Hygiene & Tropical Medicine, London, UK. Electronic address: ada.humphrey@lshtm.ac.uk.
² Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.
³ Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; UK Health Security Agency, London, UK; Whittington Health NHS Trust, London, UK.
⁴ School of Public Health, Health Education England and Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK.
⁵ Department of Primary Care and Population Health, University College London, London, UK.
⁶ Limitless Research Ltd, Park Lane Business Centre, Nottingham, UK.

PMID: 37997096
DOI: 10.1016/S0140-6736(23)02074-3

Abstract

Background: Although everyone living in the UK is entitled to access free primary care within the National Health Service (NHS), evidence shows that people in need of health care are wrongly being refused access. This study aimed to explore the perspectives of individuals from inclusion health groups on primary care registration and accessibility.

Methods: This was a mixed-methods study. From Oct 5, 2022, to Feb 20, 2023, we surveyed 49 people (36 [73%] men; 12 [24%] women) and interviewed 25 other (14 [56%] men; 11 [44%] women) who were service users of the University College London Hospital Find & Treat mobile service. This service included people with lived experience of homelessness, asylum seeking, addiction, selling sex, and irregular immigration. We recruited these participants through hostels for people with ongoing addiction and complex needs, initial asylum accommodation centres, and day shelters. Our research team included two peer researchers.

Findings: Of those surveyed, 25 (51%) perceived their access to primary health-care services as good, and 17 (35%) reported obstacles to going to the general practitioner (GP). Participants described multiple barriers to registering for GP surgeries, including a lack of understanding and poor communication with NHS services, a fear of discrimination, and a lack of digital access that prevents information seeking and access to services. Respondents also reported using emergency services instead of primary care because they were more immediately accessible without previous registration. Facilitators to GP registration included one-on-one support and outreach work that helps people navigate into services and know their rights, and the use of specialist GP services, which are perceived as more accepting, especially for people experiencing homelessness.

Interpretation: The barriers to registration identified are related to both individual and group level characteristics and produce both similar and divergent needs between different inclusion health groups. The need for additional support during registration was clear, and our work highlights the requirement for interventions to improve access to primary care for underserved groups, as well as coordinated policy action. One-on-one support in particular, either outreach or provided in services where inclusion health groups spend time, appears to be a key facilitator to ensuring comprehensive and fast access to GP services.

Funding: National Institute for Health and Care Research (NIHR).

MeSH terms

Delivery of Health Care*
England
Female
Health Services
Humans
Male
Primary Health Care
State Medicine*