Uptake of healthcare among migrants is a complex and controversial topic; there
are multiple recognised barriers to accessing primary care. Delays in presentation
to healthcare services may result in a greater burden on costly emergency care, as
well as increased public health risks. This study aimed to explore some of the
factors influencing registration of new entrants with general practitioners
Retrospective cohort study.
Port health screening at Heathrow and Gatwick airports, primary care.
252 559 new entrants to the UK, whose entry was documented by the port
health tuberculosis screening processes at Heathrow and Gatwick. 191 had
insufficient information for record linkage.
Primary outcome measure
Registration with a GP practice within the UK, as measured through record linkage
with the Personal Demographics Service (PDS) database.
Only 32.5% of 252 368 individuals were linked to the PDS, suggesting low
levels of registration in the study population. Women were more likely to register
than men, with a RR ratio of 1.44 (95% CI 1.41 to 1.46). Compared with those from
Europe, individuals of nationalities from the Americas (0.43 (0.39 to 0.47)) and
Africa (0.74 (0.69 to 0.79)) were less likely to register. Similarly, students
(0.83 (0.81 to 0.85)), long-stay visitors (0.82 (0.77 to 0.87)) and asylum seekers
(0.46 (0.42 to 0.51)) were less likely to register with a GP than other migrant
Levels of registration with GPs within this selected group of new entrants, as
measured through record linkage, are low. Migrant groups with the lowest
proportion registered are likely to be those with the highest health needs. The UK
would benefit from a targeted approach to identify the migrants least likely to
register for healthcare and to promote access among both users and service
Previous studies have suggested that access to health services for refugees and
asylum seekers is difficult.
There are limited data on access to primary care among other migrant
This study aimed to explore some of the factors influencing registration of new
entrants with GPs.
Our study indicates that less than a third (32.5%) of new entrants who are
eligible for tuberculosis screening at ports register with a GP.
Registration rates need to be improved by targeting resources to particular
subgroups (eg, students and asylum seekers) and increasing awareness of
eligibility for primary care among both migrants and GPs.
Strengths and limitations of this study
Previous studies have largely focused on asylum seekers and refugees, whereas
we examined a range of migrant groups.
Primary care registration uptake may have been underestimated for those who
migrated to Scotland or Northern Ireland, although these individuals
represented only a small proportion (2.7%) of our data set.
Port health services only screen entrants from countries with a high incidence
of tuberculosis; thus, our results are not generalisable beyond these
countries. However, these populations are likely to represent those with the
greatest health needs.