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Confused out of care: unanticipated consequences of a ‘Hostile Environment’
  1. Rose Glennerster1,
  2. Nathan Hodson2
  1. 1 St Christopher's Hospice, London, London, UK
  2. 2 College of Live Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Dr Rose Glennerster, St Christopher's Hospice, London, London SE26 6DZ, UK; rose.glennerster{at}


The UK’s 2014 Immigration Act aimed to create a ‘Hostile Environment’ for migrants to the UK. One aspect of this was the restriction of access to secondary care for overseas visitors to the UK, although it remains the case that everybody living in the UK has the legal right to access primary care. In this paper, we argue that the effects of this policy extend beyond secondary care, including preventing eligible people from registering with a General Practice (GP), although as an unintended consequence. This problem arises from misinterpretation of policy wording, misleading GP websites and gatekeeping behaviour from front-line staff, even though there are no grounds in the current guidelines or law to support this. Free access to primary healthcare among refugees and asylum seekers living in deprived populations is particularly important in protecting patient health, given the burden of ill-health in this population and the multiple barriers to accessing early intervention they face. The medical profession has a duty to communicate their rights to this patient group—their legal entitlement to access free healthcare, and the vital importance of doing so.

  • health care for specific diseases/groups
  • policy guidelines/Inst review boards/review cttes
  • primary care
  • minorities
  • right to healthcare

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  • Twitter @nathanhodson

  • Contributors Both authors conceptualised the project, conducted the research, helped draft the initial manuscript, made revisions and prepared the manuscript for submission. Both authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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