How does the impact of Covid-19 affect the work of an organisation supporting vulnerable migrants’ access to healthcare?

Problem

Covid-19 disproportionally affects people who are already vulnerable; this is particularly the case for those with BAME backgrounds (Bhatia 2020). Changes made to health care provision due to Covid have created additional barriers to accessing healthcare, especially for recently arrived and undocumented migrants (Knights 2021). Organisations such as Doctors of the World (DOTW UK) aim to help excluded people to access healthcare; however, they also have had to make a substantial change from a face to face drop-in clinic to a telephone-based remote service because of Covid restrictions.

Approach

As part of a wider study profiling the wellbeing of DOTW UK service users (Lessard-Phillips et al., 2022), we obtained a sample of 96 open text case notes completed during the pandemic (in April and July 2020) and interviewed 5 DOTW UK volunteers. Interviews were transcribed, and all data was imported into N-vivo to support data management. We conducted a content analysis of the case notes and identified domains and themes for a qualitative “domain summary” analysis (Braun & Clarke 2019) from the interview data.

Findings

Volunteers discussed a substantial change in their work due to being unable to see service users face to face. This led to increased difficulties in discussing service users’ current situation (including making sure they were safe) and being unable to pick up non-verbal cues. They also felt that it was easier for service users to develop a trusting relationship when they could interact with volunteers and other service users in a clinic environment. Helping service users to register with a GP also became more difficult, as practices had also changed to remote working and for some, registration was only possible online. The case notes also illustrate increasing difficulties in registering patients (practices saying they are not taking new patients due to Covid, online only registration for some, language barriers and lengthy processes for sending documents). We found examples for digital exclusion where service users did not have reliable access to devices, data or wi-fi. Case workers also supported service users with Covid related issues (signposting to 111 services, shielding, access to food).

Consequences

Our analysis supports the wider picture of increased barriers for the most vulnerable migrants and outlines the added difficulty for organisations supporting them. We also found that removing face-to-face interaction had a strong impact both by impeding the volunteers’ in-depth understanding of the service user’s current situation and by making it more difficult for the service user to access health care. This will remain important as more remote ways of working have been at least partly retained by many GP practices to cope with an increased post-pandemic workload.