Avoidance, distrust and inequality: A systematic scoping review of the UK resident Central and Eastern European community member perceptions and engagement with General Practice

Problem

Around 2 million people have migrated from Central and Eastern Europe to the UK since European Union expansion in 2004. The UK Central and Eastern European communities (UK-CEE) are disproportionately exposed to the social determinants of poor physical and mental health. Despite this high level of need, inequality in accessing and engaging with services has been reported in the literature. The health and healthcare beliefs of the UK-CEE community remain under-researched, particularly with regards to community cultural perceptions of primary care. The current systematic scoping review explored published academic and grey literature to identify and map what is known about UK-CEE individuals’ use and perceptions of general practice within the UK.

Approach

A systematic search of nine bibliographic databases was undertaken. Inclusion criteria were: English language; date range - 01/05/04-15/07/20; information on adult Central and Eastern European individuals’ usage of engagement with UK healthcare. 2094 identified publications met search criteria. 201 remained after deduplication and screening by title and abstract. Full text screening identified 65 publications demonstrating: at least one of the following terms: “general practice”, “GP”, “family medicine”, “family practice”, “primary care”, “doctor” (community healthcare context); a clear focus on UK-CEE migrants from A8/A2 nations; and perceptions and/or engagement with healthcare. In keeping with scoping review methodology, study design and quality did not influence inclusion or weighting. Critical appraisal was undertaken using method specific validated tools (CASP, JBI, MMAT, CEBM) to aid interpretation of findings and direct future research. Data were extracted and coded, with initial cross-checking. We used thematic analysis employing constant comparison to generate higher order thematic constructs. Community stakeholder appraisal and validation of themes was undertaken to ensure reliability and relevance

Findings

UK-CEE representation was achieved by A8/A2 nationality, gender and UK location. Comparatively low levels of GP registration were recorded, persisting over time. Community member ability, desire and actual or perceived need to engage with GP services was shaped by an intersectionality of individual community member cultural and sociodemographic characteristics. Difficulties overcoming structural and in-consultation barriers were common, with health expectations frequently unmet. Distrust and dissatisfaction with general practice became embedded over time, promoting alternative health seeking approaches including transnational healthcare. Marginalised UK-CEE community subgroups had particularly poor levels of GP engagement and outcomes, including Roma, trafficked and homeless individuals.

Consequences

Our findings highlight the need for policy and clinical approaches to remove barriers to general practice access and care for UK-CEE individuals. In keeping with community member candidacy and recursivity, greater exploration of how the commonalities and differences in health seeking and care expectations within and between UK-CEE subgroups (and other marginalised groups) is required to identify what works for whom and why.