REFUGEE HEALTH IN CROYDON

Refugees and asylum seekers are among the most isolated and vulnerable groups in the community. Most have left their home countries because of immediate danger to themselves or their families. Many will have been subjected to torture, rape or sexual abuse. Relatives and friends may have been killed or disappeared. Many of those who arrive in Britain have professional qualifications and experience a drastic reduction in their standard of living.

The number of refugees and asylum seekers arriving in Croydon has increased in the past year or so and temporary accommodation is now at saturation point.

A health needs assessment is being conducted by the Department of Public Health to clarify the situation in Croydon and a report will be published shortly. Many of the findings are relevant to Primary Care and to local Primary Care Groups.

We estimate that there are about 4000-6000 refugees in Croydon, of whom around 1000-1500 are new arrivals. The largest groups represented locally are the Somali, Congolese, Turkish-speaking, Sri Lankan and Eastern European communities.

Key health issues

Refugees are a heterogeneous population with a variety of different health and social welfare needs, which vary over time. Basic needs for food, shelter and security are the first priority, then English language proficiency, employment and education become more important. Immigration status and money are also major concerns. Unless refugees are unwell health issues tend to be a lower priority. For certain conditions (e.g. tuberculosis) this can have implications both for the individual and the public health. It is important that refugees are able to access appropriate health care. They also need to register permanently with a GP so that they have access to screening and immunisation as well as other care.

Some new arrivals in Croydon are experiencing difficulties registering with a GP and Croydon Health Authority has recently been asked to make allocations for some asylum seekers. There are several factors that may be contributing to this including the increase in numbers, the mobility of the population, confusion about entitlement to care under the NHS and language difficulties.

Refugees should be regarded as ‘ordinarily resident’ in the UK, and are entitled to the full range of NHS services, free of charge, including permanent registration with a GP (HSC 1999/018). There is no obligation to GPs to check refugees’ documentation: if a person states that he or she is a refugee then that person and their family may be accepted for NHS care.

Some health problems are more common among refugees including a higher rate of mental illness associated with social exclusion and trauma, problems relating to particular cultural practices such as female genital mutilation and infectious diseases such as tuberculosis and tropical diseases.

The war in Kosovo may lead to large numbers of refugees arriving in the UK. Croydon Health Authority is currently working with the Local Authority to prepare contingency plans for providing social and health care for those placed in Croydon.

In order to ease the referral procedure and to continue to meet the national two week waiting time target for patients with suspected breast cancer, every GP in Croydon is being asked to adopt the new Breast Clinic Referral Proforma which will be distributed soon.

Recent well publicised targets from the government include important ones for any patient suspected to have breast cancer.

The Breast Cancer Unit, run by Mr Steve Ebbs at Mayday University Hospital Trust already meets these targets for the care of breast cancer.

To help ensure that the women of Croydon continue to receive the best level of service, a Breast Clinic Referral Proforma has been developed by a panel of GPs, Mr Ebbs and Public Health.

The proforma will allow easier referral to the relevant Mayday breast clinics. It has a quick tick-box style covering different presentations and symptoms; it has space for clinical diagrams and for any additional comments. Being a single sheet it is ideal for fax transmission direct to the clinic booking secretary’s desk. Every form is individually numbered to allow clear tracking of the referral, monitoring the two week target and analysis of the outcomes of referrals. The information will also contribute to the overall service monitoring of the breast clinic.

For the first six months the form will be piloted. It has been prepared in pads of 50 sheets each, one pad for each practice in Croydon; these will be sent out by the start of May 1999. In the trial period it is important that all GPs use the form, so that a final version can meet the needs of everyone using it. At the end of the pilot, the form will be reviewed and amended as necessary.

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The first Croydon wide Clinicians’ Forum attended by over one hundred nurses, therapists and professions allied to medicine, was held on 10 March at the Fairfield Halls.

The aim of the forum was to:

Lead members of each profession were identified in order to facilitate the networking process within Primary Care. A follow up meeting of the Clinicians’ Forum will be held in June this year.

PCG Nurse representatives will be holding monthly surgeries commencing May 1999, all clinicians are welcome. Dates and venues are as follows.

27.05.99 North PCG Woodside Health Centre 1:00 – 2:00pm

23.06.99 Central PCG Waddon Health Centre 12:30 – 1:30pm

30.07.99 South PCG Coulsdon Resource Centre 12:30 – 1:30pm

NO SURGERY IN AUGUST

23.09.99 Central P.C.G. Parkway Health Centre 12:30 – 1:30pm

20.10.99 South P.C.G. Purley Clinic 12:30 – 1:30pm

23.11.99 North P.C.G. Norbury Health Centre 12:30 – 1:30pm

17.12.99 Central P.C.G. Parkway Health Centre 12:30 – 1:30pm

Names and contact numbers of PCG Nurse Board Representatives

North P.C.G.

Maggie Ioannou                              Marion Padgham

Norbury Health Centre                     Woodside Health Centre

0181 679 1700                                0181 656 0213

Central P.C.G.

Maree Jones                                    Liz Baker

Waddon Health Centre                      Parkway Health Centre

0181 686 3632                                 01689 842554

South P.C.G.

Sarah Baker                                     Lisa Eve

Morland Road                                   Keston House Medical Practice

0181 656 6722                                 70 Brighton Road

                                                      Purley CR8 2LJ

The Secretary of State for Health has recently confirmed that NHS Direct will be provided in South West London from December 1999. A call centre will be established at Mayday Hospital and will provide services for the populations of Croydon, Merton, Sutton, Wandsworth, Kingston and Richmond.

What does NHS Direct Do?

The service has three objectives:

A steering group has been established involving the three Health Authorities, six Local Authorities, a representative from the Community Health Councils, Social Services, GPs, Community, Acute and Mental Health Trusts. Detailed planning has begun to ensure that the call centre will be operational by December 1, 1999.

The service will initially provide nurse triage and advice to callers. In providing advice, nurses will be using a computerised expert clinical decision making system which prompts them to ask the caller a series of structured questions about the caller's condition. The system assists the nurse in using the answers to the questions to determine which action the caller should be recommended to take. The recommended action may be, self care using over the counter medicines, visiting a pharmacist for face to face advice, arranging to see a GP within a certain time period, or attending secondary care services.

The service will expand to include a wide range of more general advice about local health and social services. We are working with Local Authorities and the College of Health to develop this aspect of the service.

Initial feedback from service users in other parts of the country has been very positive. An independent caller survey by Sheffield University showed a 97% satisfaction rating.

Future developments of the service that are currently being piloted in different parts of the country may include the following.

NHS Direct Outreach – Using NHS Direct nurses to proactively call people who may need advice or help, e.g. calling people who might benefit from a flu jab to remind them that it is due.

NHS Direct Online – Providing the public with a gateway to health information on the Internet and public access to the new National Electronic Library for Health.

NHS Direct Information Points – Providing public access points to the service in surgeries, libraries, pharmacies, post offices, accident departments.

NHS Direct Healthcare Guide – To provide advice on common ailments and problems which NHS Direct nurses routinely advise callers about.

NHS Direct Healthcare Programme – To provide training for the public on basic healthcare issues increasing their knowledge and ability to look after themselves.

We will be producing regular information sheets to inform you about progress and these will be circulated with future issues of Link News.

Please Note:

Tetracycline-like medicines kill the clostridia bacteria in the colon, whose action is needed to enable reabsorption of oestrogens to re-enter the circulation and further biological action of oestrogen.

Sorry if this has caused some confusion. If anyone is interested in seeing the quiz, please contact Lorna at the Link Office.

The address of our Link Office web site has changed to:

Apologies for those of you who have been unable to find it at the previous address: we have been moved on from the Direct Connection service provider! I am currently involved in negotiations with ‘E-Pulse’ about incorporating these pages within its site so that we have the advantage of password protection. Eventually we should have a mirror site on the NHSnet. As with any move, there have been technical problems and some of the web links do not work as they should. Feel free to send in corrections or even sites which you feel should have links on our page.

Part-time receptionists (two) required: one for 14 hrs and one for 12 hrs per week.

Computer operator/administrator required part-time for 12 hrs per week.

Practice Nurse part-time required for 9 to 12 hrs per week.

Please apply with CV to Practice Manager, Beddington Medical Centre, 172 Croydon Road, Beddington, Surrey, CR0 4PG. Tel No: 0181 688 8486.

GP Retainer required for busy five-partner practice in Sanderstead, South Croydon. Up to four sessions per week, BMA rates. Please apply in writing, enclosing CV, to Practice Manager, 53 Farley Road, South Croydon, Surrey CR2 7NG.

Part-time experienced secretary/receptionist required 20 hours per week, previous general practice experience would be useful but not necessary. Must have good W/P, telephone manner, computer and filing skills. For details please send CV to: Mrs Margaret Fidler, Practice Manager, 60 Central Hill, Upper Norwood, London SE19 1DT. Tel: 0181 670 7117.

GP locum available - Please contact the GPLO on 1081 401 3990 for details