Contents
- Lifestyle related illnesses and hypertension
- Cancer
- Mental health
- Immunisation
- Maternity services
- Children and young people
- Rough sleepers and homeless community members
- Introduction to the Roma health guide
- Barriers to healthcare for the Roma community
- System barriers
- Language barriers and communication
- Cultural barriers - Common health problems and vulnerable groups:
- Lifestyle related illnesses and hypertension
- Cancer
- Mental health
- Immunisation
- Maternity services
- Children and young people
- Rough sleepers and homeless community members
System barriers
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Knowledge of health systems
Many Roma are relatively recent arrivals to the UK and are unfamiliar with how the NHS works - from their right to healthcare, to basic information about following care pathways or visiting a hospital.
For some services there are long waiting times for NHS referrals, where in some other countries it is possible to self-refer to elective care without consulting your GP, such as in gynaecology or ears, nose and throat (ENT) services. This often results in confusion about care pathways and delays in seeking treatment, sometimes leading to untreated long-term conditions and late diagnosis instead of a planned approach to healthcare. This can lead to the patient eventually presenting at A&E with a serious condition.
There may be other barriers preventing Roma patients from attending scheduled appointments. For example, they are often unable to navigate the public transport system due to language barriers, which puts a strain on their time and finances. Local healthcare systems could investigate to better understand why some Roma patients did not attend appointments.
For some services there are long waiting times for NHS referrals, where in some other countries it is possible to self-refer to elective care without consulting your GP, such as in gynaecology or ears, nose and throat (ENT) services. This often results in confusion about care pathways and delays in seeking treatment, sometimes leading to untreated long-term conditions and late diagnosis instead of a planned approach to healthcare. This can lead to the patient eventually presenting at A&E with a serious condition.
There may be other barriers preventing Roma patients from attending scheduled appointments. For example, they are often unable to navigate the public transport system due to language barriers, which puts a strain on their time and finances. Local healthcare systems could investigate to better understand why some Roma patients did not attend appointments.
GP registration
Roma patients often have difficulty registering with a GP due to lacking ID documents or proof of address, or lacking proof of previous childhood immunisations in the case of registering children. This may be from losing documents due to moving frequently, living in sublets, or utility bills issued to someone else. Often children have been vaccinated, but their parents lack proof of their previous immunisations.
It is important you make it clear that everyone in the UK is entitled to primary care, irrespective of immigration status, immunisation status, ID or proof of address.
There is no contractual duty for GPs to seek evidence of identity, immigration status or proof of address. So, practices should not refuse registration on the grounds that a patient is unable to produce such evidence. However, many GP practices make these documents a condition of registering. Many Roma also do not understand the common practice of temporarily closing registration of new patients.
It is important you make it clear that everyone in the UK is entitled to primary care, irrespective of immigration status, immunisation status, ID or proof of address.
There is no contractual duty for GPs to seek evidence of identity, immigration status or proof of address. So, practices should not refuse registration on the grounds that a patient is unable to produce such evidence. However, many GP practices make these documents a condition of registering. Many Roma also do not understand the common practice of temporarily closing registration of new patients.
Immigration status
Most Roma are citizens of an EU country, and the requirement to prove they are entitled to healthcare has changed after the end of freedom of movement in the UK. EU citizens living in the UK who do not have settled or pre-settled status under the EU Settlement Scheme, and have not yet applied for status under the scheme, will no longer be entitled to free secondary healthcare until they make a valid application.
The exception is EU citizens with other types of immigration status not under the EU Settlement Scheme. This includes people with:
If you have EU citizen patients who have not yet applied to the EU Settlement Scheme and do not have other valid immigration permission, you should advise them that if they access secondary healthcare before making a valid application to the scheme, they can be charged for their treatment. They should apply to the scheme as soon as possible to avoid any NHS charges, and you should signpost them to accredited immigration advice if they need further support.
Primary and emergency care from GPs, A&E or walk-in centres is free of charge for everyone. For further detail see: Migrant health guide: NHS entitlements.
The exception is EU citizens with other types of immigration status not under the EU Settlement Scheme. This includes people with:
- valid indefinite leave to remain or enter from before freedom of movement applied, or from before the citizen’s country joined the EU
- limited permission to remain under the new points-based system, who will also be entitled to free NHS care at the point of access (having paid the immigration health surcharge as part of their visa application)
If you have EU citizen patients who have not yet applied to the EU Settlement Scheme and do not have other valid immigration permission, you should advise them that if they access secondary healthcare before making a valid application to the scheme, they can be charged for their treatment. They should apply to the scheme as soon as possible to avoid any NHS charges, and you should signpost them to accredited immigration advice if they need further support.
Primary and emergency care from GPs, A&E or walk-in centres is free of charge for everyone. For further detail see: Migrant health guide: NHS entitlements.
Lack of knowledge from health and care professionals
Many NHS commissioners and health practitioners are insufficiently aware of the Roma as a distinct ethnic group and of the community’s healthcare needs. This has been reflected in resource allocation, where few local joint strategic needs assessments have included the needs of Roma people, and even fewer identified any positive actions to tackle health inequalities for these communities.
Local planners and primary care services should gather information about all populations they serve, including Roma communities.
Voluntary sector organisations and community groups are likely to hold intelligence and data that the health and care system lacks. Also, health and care professionals should link up with Roma-led and Roma-supporting organisations to understand how to address inequalities and reach out to Roma patients locally.
Local planners and primary care services should gather information about all populations they serve, including Roma communities.
Voluntary sector organisations and community groups are likely to hold intelligence and data that the health and care system lacks. Also, health and care professionals should link up with Roma-led and Roma-supporting organisations to understand how to address inequalities and reach out to Roma patients locally.
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