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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.