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Letters to the Editor

Breaking Barriers to Health Care in the United Kingdom

Rathbone, Ruby

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doi: 10.1097/ACM.0000000000002973
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To the Editor:

I was excited to read Bernhardt and colleagues’ article about the Refugee Health Partnership’s (RHP’s) positive results in bringing together preclinical students with recently settled refugees in the United States.1 As a British medical student, though, the RHP made me wonder if similar programs might have a role in the United Kingdom too.

In the United States, it is commonly accepted that there are barriers to health care. By contrast, most British medical students, particularly those born and raised there, have little to no direct experience with anything other than the National Health Service’s (NHS’s) universal health care system, free at the point of delivery. As part of a transatlantic family, with my mother living in London and my father in New York, I am perhaps more attuned to such differences.

Subtle barriers to health care in the United Kingdom do exist. Everyone, regardless of immigration status, is entitled to NHS primary health care.2 Yet, under recent legislation enacted in 2015, upfront payment is now required for inpatient care if identity documentation cannot be produced.2 The effects have been dramatic. A report by the charity Doctors of the World (DoTW) found that 89% of attendees at their pro bono clinic were not registered with an NHS general practitioner.3 Moreover, 53% had never attempted to access NHS services because of perceived barriers, including fear of arrest.3 The NHS’s own administrative barriers play a further role. When DoTW sought to enroll refugees/asylum seekers, over 20% were refused.4 With the future of the NHS ever uncertain, such barriers are likely to increase. The consequences for public health and vulnerable individuals are alarming.

Thankfully, the RHP suggests a solution applicable to the United Kingdom. If U.K. medical students were to engage in enrolling refugees into British health care, the NHS’s often invisible barriers would be revealed and overcome. British medical students, meanwhile, would gain the valuable communication skills and patient understanding so vividly described by the RHP. The results would create a win–win situation.


1. Bernhardt LJ, Lin S, Swegman C, et al. The Refugee Health Partnership: A longitudinal experiential medical student curriculum in refugee/asylee health. Acad Med. 2019;94:544–549.
2. Public Health England. NHS entitlements: Migrant health guide. Updated July 31,2019. Accessed August 7, 2019.
3. Doctors of the World UK. Closing the gaps in healthcare access: The United Kingdom. Published 2017. Accessed August 7, 2019.
4. Doctors of the World UK. Registration refused: A study on access to GP registration in England. Updated December 7,2018. Accessed August 7, 2019.
Copyright © 2019 by the Association of American Medical Colleges