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Br J Gen Pract. 2016 August; 66(649): 405.
PMCID: PMC4979919

Migrant health

David Bernard Lehane, NIHR Clinical Lecturer and GP
Academic Unit of Primary Medical Care, Northern General Hospital, Sheffield. E-mail:
Alicia Vedio, Infectious Diseases Physician, PhD Student
University of Sheffield.
Ann Gregory, Practice Nurse
Page Hall Medical Centre, Sheffield.
Caroline Mitchell, GP and Senior Clinical Lecturer

The articles in the recent BJGP ‘Vulnerable people’ themed issue highlight an issue of importance to UK practices serving diverse populations.1,2 Page Hall Medical Centre adopted an ‘opt-out screening’ process for blood-borne viruses (BBV) in 2007 as part of our ‘new patient medical examination’. We undertook a prospective audit of the outcomes of this intervention, by self-assigned ethnicity, country of origin, and language spoken, and noted increased rates of hepatitis B virus (HBV) positive results (9.4%)3 from migrant workers who identify themselves as Roma Slovak. This contrasts strongly to the stated HBV prevalence in the wider Slovakian population (<0.6%).4 Our adoption of an ‘opt out BBV screening’ policy for all new patients has identified an at-risk group that would not have been screened had we strictly adhered to NICE guidance.5

Presentation of our audit data prompted the commissioning of a Local Enhanced Service to facilitate testing and contact tracing for HBV of the newly-arrived Slovakian citizens.

Our commitment to providing culturally congruent care alongside practice audit has led us to conclude that the stated background prevalence for certain countries may not accurately reflect the needs of distinct ethnic or disadvantaged groups that have recently arrived in the UK. A ‘one-stop new patient medical’ with ‘opt-out’ BBV screen allows a comprehensive health screen of new migrants and early BBV detection, intervention, and contact tracing for high-risk vulnerable groups unaccustomed to NHS models of care.


1. O’Kelly M, Byrne D, Naughten E, et al. Opt-out testing for blood-borne viruses in primary care: a multicentre, prospective study. Br J Gen Pract. 2016 doi: 10.3399/bjgp16X685225. [PMC free article] [PubMed] [Cross Ref]
2. Evlampidou I, Hickman M, Irish C, et al. Low hepatitis B testing among migrants: a cross-sectional study in a UK city. Br J Gen Pract. 2016 doi: 10.3399/bjgp16X684817. [PMC free article] [PubMed] [Cross Ref]
3. Gregory A, Vedio A, Stone B, et al. Targeted testing in primary care demonstrates high prevalence of hepatitis B infection within the Slovak-Roma population in Sheffield, UK. J Viral Hepat. 2014;21(10):138–139. [PubMed]
4. European Centre for Disease Prevention and Control Hepatitis B and C in the EU neighbourhood: prevalence, burden of disease and screening policies. 2010. (accessed 5 Jul 2016)
5. National Institute for Health and Care Excellence . Hepatitis B and C testing: people at risk of infection PH43. London: NICE; 2012. (accessed 5 Jul 2016)

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners