Intended for healthcare professionals

Rapid response to:


Primary care for refugees and asylum seekers

BMJ 2006; 332 doi: (Published 12 January 2006) Cite this as: BMJ 2006;332:62

Rapid Response:

Underfunding of primary care in deprived areas affects everyone


The paper by McColl (1) and the commentary by Hull and Boomla (2),
important questions about the provision of primary care in areas with high

levels of deprivation. It is misleading to focus on refugees and asylum
seekers as it suggests that the only problem is one of discrimination
this group – although there may be some truth in this assertion, the
reality is
far more complex. There is a problem with accessing primary care for all
Tower Hamlets residents and by extrapolation, for those in other areas
similar populations.

This is nothing new - such communities have always been relatively under-resourced. But what has changed is the clamour for increased quality of
service provision and increased levels of access at the same time as there
been a shift of work from secondary to primary care. Primary Care Trusts,
contrast, find themselves in the unenviable position of having to cajole
general practitioners into quantifiable action whilst being squeezed by
Department of Health to deliver increasingly unrealistic targets.

primary health care teams grapple with recruitment and retention and at
capacity, struggle to balance service delivery from their inadequate
when there is little hope of improvement.

In this climate it is small wonder that registration with primary care is
problematic. If Project-London effectively highlights this issue and
funding comes our way, fine, but the reality is that greater pressure will
exerted on the same workforce and that there will be no extra public

Dr James Hardy

(1) McColl K, Pickworth S, Raymond L. Project: London - supporting
vulnerable populations. BMJ 2006; 332: 115-7

(2) Hull S & Boomla K. Primary care for refugees and asylum seekers
BMJ 2006; 332: 62-63

Competing interests:
I am a general practitioner in
Tower Hamlets

Competing interests: No competing interests

16 January 2006
james n hardy
GP principal
Bethnal Green Health Centre, 60 Florida Street, London E2 6LL