Access to healthcare for vulnerable migrants - one year on: How can medical student advocates influence local primary care ?

Problem

At SAPC 2018 we presented our Access to Care project. This developed following a workshop for fourth year students regarding UK legislation limiting access to healthcare for undocumented migrants. Students proposed an advocacy project looking at ways to improve access to primary care for migrants encountering difficulty at registration.East London is an area of high deprivation and diversity. Students are exposed to increasing to those whose health are affected by sociopolitical factors such as austerity and "hostile environment". The role of the socially accountable medical school includes preparing students for their role as potential advocates for vulnerable patients and communities.Advocacy can be defined as : “Action by a physician to promote those social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being that s/he identifies through his or her professional work and expertise” (LM. Luft 2017 ) .

Approach

Access to Care is a student led project supported by primary care faculty. Two students (PS and IO) recruited peers to undertake a local intervention during final year GP placements. They delivered 2 training sessions and seven students participated in the project. Consent was sought from practice staff. Registration policies and practices were explored through semi structured conversations with clinical and administrative staff. Each student wrote an individual report and the data was collated and analysed thematically.

Findings

Our presentation will describe our thematic analysis. Challenges to registration included :• Lack of awareness of current NHS guidelines regarding access to care by staff• Issues around completing computerised registration system without specific documents• Queries about contacting people without a registered address• Discomfort around using the practice address as alternative for correspondence• Financial concerns relating to practice budget• lack of trust for people without documentationStudent authors will describe the impact on practices and on local CCG registration policies They will also include critical reflection on their learning through this work.

Consequences

What do your findings mean and why do they matter? For work in progress consider the potential to influence outcomes.Firstly we have seen student advocacy in action and aim to embed further in our curriculum led by an academic GP trainee. We have learned about the challenges and limitations to sustaining student involvement in advocacy. Importantly data gathered by the students has been used to inform the development of online registration tool and therefore has already had impact on local policy and practice regarding "Safe Surgeries" . Ensuring student advocacy is aligned to local needs is a priority.