Manager Practice


Janette says: “They present with everything and


anything. It’s very varied. There’s a lot of abuse and mental health issues. Some come from war torn areas where they may have watched their family members suffer.” And there is the additional consideration of patients’


immigration status. BMA guidance Access to health care for asylum seekers and refused asylum seekers – guidance for doctors states that practices are not required to check the identity or immigration status of people registering to join their lists and prospective patients are not obliged to provide evidence in this regard. While practices are not forbidden from doing so, the BMA advises they proceed with caution to avoid discriminating against particular groups of patients.


CULTURAL COMPETENCE Communication is key within any multicultural practice and it is important that staff are “culturally competent”, which means they know how to effectively interact with patients from different cultural backgrounds. Many NHS trusts or health boards have practical infor-


mation available for staff, such as the Cultural Competency Toolkit (www.tinyurl.com/6knxtlk) from West London Mental Health Trust. The booklet aims to fill the gaps in knowledge regarding the culture, customs and practices of ethnic minority patients and high- lights the importance of being aware of cultural differences. It urges staff to find out as much as they can about the needs of ethnic minority patients and to try to understand the differences in their values and lifestyles. One simple example highlights


how people of south Asian origins are generally not accus- tomed to routinely saying ‘please’ and ‘thank you’ – a custom that could be misinterpreted in the UK for rude- ness or ingratitude. The toolkit offers tips to healthcare staff when speak-


ing to patients with little or no English. It recommends speaking slowly and clearly without using jargon or acronyms and without raising your voice. It underlines the importance of regularly checking the patient is following


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what you are saying but advises against asking “Do you understand” or “Is that all right?” as the answer will almost always be yes. The guidance explains: “Yes is often the first word someone learns in a foreign language, but does not necessarily indicate that they understand.” Staff are also advised to be aware that people who speak English as a second language may be less able to remember large chunks of information. The guidance recommends providing a simple note for the patient to refer to once they have left.


PATIENT EXPECTATIONS Recent research suggests there is still room for improvement in the provision of primary care services to patients born abroad. One study suggests a number of practices in England are not meeting the expectations of some of these patients. The latest English General Practice Patient Survey published in September 2011 in BMJ Quality & Safety has found that some patients from minority ethnic groups are not satisfied with NHS primary care services. Despite efforts to provide a healthcare system that offers


universal coverage, the research shows satisfaction is particularly low among people from south Asian and Chinese backgrounds, as well as younger patients and those in poorer health. Bangladeshi, Pakistani, Indian and Chinese patients gave


IT’S IMPORTANT NOT TO TREAT PATIENTS FROM OTHER COUNTRIES DIFFERENTLY. EVERYONE AT OUR PRACTICE IS TREATED THE SAME


their practices significantly lower scores for professional communication than either white British or black patients. Researchers say the fact that patients from these ethnic backgrounds tended to be clustered in generally low performing practices accounted for half of this difference for south Asian patients and for 14 per cent of that for Chinese patients. The authors argue: “Substantial ethnic differences in


patient experience exist in a national healthcare system providing universal coverage. If the overall performance of low-performing practices were improved (as is the goal of a series of major UK Government policy initiatives), this would also help improve the patient experiences of south Asian and Chinese patients.” The research serves as a timely reminder to managers


to ensure all the necessary practice systems are in place and that staff are equipped with the right skills to care for the growing multicultural community. 


Joanne Curran is associate editor of publications at MDDUS


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