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Views And Reviews Primary Colour

Helen Salisbury: A hostile environment in the NHS

BMJ 2019; 366 doi: (Published 17 September 2019) Cite this as: BMJ 2019;366:l5328
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on Twitter: @HelenRSalisbury

A temporary resident recently attended our practice after coughing up blood. The likely cause was pneumonia, but tuberculosis and malignancy were on the list of differential diagnoses. My colleague duly sent the patient for chest radiography, but the request was refused as the patient—a visitor to this country—did not have an NHS number. We were told that radiography would be possible if the patient attended the emergency department.

This is surely dangerous. From a public health perspective, highly infectious diseases—in this case possible open tuberculosis—must be diagnosed and treated as swiftly as possible. Primary care is available to everyone in the UK, so I …

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