The BMJ Christmas appeal 2018: a new clinic for the UK’s most vulnerable patientsBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k5165 (Published 13 December 2018) Cite this as: BMJ 2018;363:k5165
The Doctors of the World clinic in Bethnal Green, east London, is the last word in no frills healthcare. Its volunteer staff—four support workers and two clinicians, normally GPs, at any one time—cram into the dingy back basement of a decaying Victorian church in London’s east end.
Since 2006, however, this permanent clinic has been a beacon of hope and a last resort for tens of thousands of people who are effectively excluded from mainstream health services in the UK.
The global charity Doctors of the World (Médecins du Monde) is The BMJ’s Christmas charity this year. Such is the demand for its services, donations could help the charity’s plan to move the Bethnal Green clinic to larger premises in Stratford and to open new permanent clinics in other UK cities such as Birmingham.
Under the radar, often destitute
“The people who come here are living and often working in our communities, yet they are under the radar, often destitute, frequently undocumented, and without access to the commodities that we take for granted,” says Sarah Pillai, a GP in Winchmore Hill, London. She is one of 30 GPs on the charity’s rota, providing a minimum of one session a month.
Maria (not her real name) is a nanny in north London who has severe eczema, a problem that she might be able to manage with prescription drugs. But, as an undocumented migrant, she was turned away from registering at her local general practice and had little choice but to endure “unbearable” itching, she tells The BMJ.
Originally from the Philippines, Maria escaped last year from an abusive employer in Dubai during a visit to London, without her passport. “I was working very long hours, seven days a week, for almost no money,” she says.
She is one of thousands of people—including undocumented migrants, asylum seekers, and survivors of human trafficking—who are wrongly denied NHS healthcare and instead turn to Doctors of the World for help. Last year the charity’s volunteer doctors helped 1617 people in the UK.
In 2016 nine in 10 patients visiting the clinic were not registered with a GP, and 94% reported difficulties in accessing healthcare. “These are patients in desperate need, typically after managing in the UK with very limited healthcare provision for an average of six years,” explains Philomena Dardis, a retired GP who volunteers at the clinic.
Pillai, a sexual health specialist, routinely sees women who have managed without access to healthcare until they become pregnant. She says, “At that point healthcare is essential but it’s often unaffordable, especially when charges are, wrongly, demanded in advance.
“At the same time these women have to share their details with authorities, facing the anxieties of being arrested, detained, or deported. We can save lives here by negotiating access to healthcare under NHS rules.”
Time to listen
Just 15 patients a day attend the clinic, with appointments lasting 90 minutes on average. This gives doctors time to hear people’s stories, using telephone interpreting.
Dardis recalls a patient who had been trafficked from Africa and forced into prostitution in the UK. “I had time to listen,” she says. “[The patient] found it difficult to tell her story through a mixture of shame and fear—not just of her traffickers but also the UK authorities. It helped that I was a doctor that she felt she could trust.”
The woman was helped to get emergency healthcare and registered with a GP. The priority, however, was to contact another charity to arrange a referral to a safe place the next day. “She is now settled and safe, having escaped a life of prostitution,” says Dardis.
Such connections with other organisations enable the charity to change people’s lives. People come to the clinic for healthcare but get much more, as Pratheep Suntharamoorthy, a GP in Buckhurst Hill in northeast London, points out on the charity’s website.1
Urgent prescription medicines
Consultations at the clinic involve everything that GPs see: musculoskeletal conditions, gynaecological problems, and high blood pressure, as well as depression and anxiety. Patients are referred for medical check-ups and for sexual health and tuberculosis screenings in partnership with London teaching hospitals (Barts Health and University College London Hospitals).
Patients frequently need repeat prescriptions. And, alongside helping to fill in exemption forms, the charity pays a local pharmacy to distribute urgent prescription medicines such as eczema cream, scabies treatment, blood pressure tablets, and antibiotics.
But perhaps the most time consuming work is finding practices that are willing to take these most vulnerable patients. As Suntharamoorthy explains, “GP surgeries ask our patients for identification and address documents that they don’t have, and there are language barriers too. Going to a GP in those circumstances can be very daunting.”
Phoning five or six practices
Doctors of the World makes a difference by contacting practices near where patients live and asking for them to be registered. “For a person with no documents we often have to phone five or six practices,” says Katherine Taylor, a locum GP and the charity’s health adviser. “Once a patient has been turned down by more than six practices we escalate the case to NHS England.”
Contrary to the widely held belief that proofs of identity are required, NHS general practices that refuse access to undocumented would-be patients “are in defiance of NHS guidelines which state that there is no need for new patients to provide any proof of identity,” says Taylor.
On Doctors of the World’s website, Suntharamoorthy bears witness to the impact on patients’ health when they can’t register with a GP.1 He describes seeing two patients on the same day who had had emergency hospital treatment but had no GP for essential follow-up care.
In May 2018 Taylor took on a new role as GP champion for Safe Surgeries—an initiative that provides networking, training, and resources to raise awareness among general practices to ensure that they don’t exclude vulnerable people living in their communities. So far 71 practices in 10 UK cities have signed up, and the clinic provides constructive support for all parties to smooth out misunderstandings.
Dardis says, “We recognise that taking on patients who don’t speak the language and with unknown healthcare needs can appear to be overwhelming to already stretched practices, and we can help.
“As well as giving patients the immediate help they need, we can also support patients to understand what to expect from healthcare and how to access it. That can make a huge difference.”
Permanent clinics outside London
Doctors of the World already provides pop-up clinics for groups that are hard to reach, such as members of Justice for Domestic Workers.2 Provided it has sufficient funding, the charity also plans to open much needed permanent clinics outside London from 2019.
Once it moves into the new Stratford clinic Doctors of the World hopes to offer permanent services including dentistry, ophthalmology, family planning, and HIV and sexual health screening.
Taylor says, “It will be great for everyone, volunteers as well as patients, to have somewhere newer, brighter, and more spacious.” But, as well as an increase in rent, the clinic has an urgent to-do list—including upgrading its ageing donated equipment.
“It’s not particularly glamorous,” admits the charity’s administrator, Phil Murwill. “But getting funds to upgrade our database and replace laptops that are constantly crashing could make a huge difference to the quantity of healthcare we can provide.”
Doctors of the World’s volunteers need your support: please give generously.
£135 (€152; $172) buys a medical backpack for a mobile medic working around Europe
£240 (€270; $306) can help 300 mothers in Yemen test their children for malnutrition
£325 (€365; $414) could pay for five vulnerable people to see a volunteer doctor at a UK clinic.
Donate online: www.doctorsoftheworld.org.uk/BMJ
Donate by phone: 020 7167 5789
Registered charity number: 1067406
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.