Challenges in Primary Care


We had many problems relating to not speaking the same language. It was difficult to get access to appropriate interpreters, especially when there was an urgent medical need. Translation is sometimes difficult. There isn’t always a literal translation from English to the child’s native tongue, needing to re-work what we said, and simplify explanations.

We also encountered Religious issues, there was a need for appropriate places for worship. We always had to have respect for their needs related to food and religious festivals.

A lot of the children/young people were frightened, hyper-vigilant and suspicious.  Many had been failed or let down by supposed people in authority or ‘professionals’. It took time to build up a rapport and get a complete story. Their trust had to be earned. Sometimes it took more than one or two consultations to be given all of the facts.


The legal aspects of what to share, when, to whom and why. We were often asked by various agencies for information with no signed consent by YP to release it. It’s not an aspect they are familiar with, being asked for their consent – we needed to explain the pros and cons, not to make them feel pressured no matter who is asking.


Many of the children / young people have very similar names and the same or very similar dates of birth, such as Mohammed, Mohamed, Muhammed, Muhamed.

Documentation must be 100% accurate between staff and agencies, using  a 3rd identifier at least if possible. Name to be full, in the correct order, such as Mohammed Ali or Ali Mohammed a DOB and NHS number as a minimum.  We also got photographic ID for every child. It is important to double check everything to reduce the risk of errors.


We needed to be ensure the health and safety of the children, staff, us, and other residents. There were unknown communicable diseases such as Hepatitis B.
Any challenging behaviours would be dealt with effectively and preventative actions taken.
Protection must be taken including wearing gloves with body fluid spillages. Risk assessments were also completed                                                                                                                                   

What the child or young person expects, has been told or led to believe the experience in the UK will be. The reality can be very different leading to frustration and anger.


When moving from our unit the continuity of care is important, communication between agencies to ensure hospital follow ups, medications and investigations, linking all the correspondence form different departments and agencies to the child’s new place of residence.


Attitudes were a big consideration both from the UASC’s and from the staff working with them. The Young people needed to be taught about British Culture, respecting women, and appropriate behaviour towards women and other people.

The staff attitudes were sometimes that of Indifference, lack of understanding, and a lack of sensitivity. Which also needed to be changed just as much as the young people.

by Jacqueline Nudd

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A Practice Nurse’s story

PersonMy name is Jacqueline Nudd. I am a State registered, Sick Children’s and District Nurse. I have worked in Neo-natal intensive Care, Accident and Emergency, School Nursing, Sexual medicine, acute surgical wards and for the past 26 years the only Practice Nurse in a rural 3,500 patient practice also covering two private schools. I specialise in Asthma along with dealing with Travel Health/medicine, child immunisations, chronic disease management, wound care and all other practice nurse tasks. I can safely say I don’t think there is any part of the skills and knowledge I have obtained over my nursing career that hasn’t been tested in this role. It is truly unique.


Firstly we needed to ensure all of the children in the unit are registered with the GP to get an NHS number and access health care to which they are all fully entitled.

I set up and ran clinics with a GP at the centre, co-ordinating with support workers and appropriate interpreters for each child. We would deal with common conditions seen in the children/young people such as; scabies,  athlete’s foot but also needed to have a heightened sense of awareness of signs and symptoms of conditions not normally seen in UK children, such as Malaria.

I was involved in advising on Issues regarding; control of infection, clinical waste and the use of agencies such as PHE.

Important discussions were had with all staff, both at the unit and within the practice, regarding information sharing, confidentiality, consent & the law, dealing with communication difficulties when no interpreters were available.

Immunisation was a big part of my role, and a big question was “how do we obtain ‘informed consent’?” A consent form was devised to be used specifically for these children. This was created using ‘The Green Book’ and The ‘Guidelines for those of unknown immunisation status’

Another issue we had to deal with was age disputes – there are a lot of documents and papers on age assessment, this is particularly relevant with UASC’s, and a great deal of caution is needed. This area caused us a lot of problems especially with care when the appearance of a child seemed much older than their documented date of birth.

I was responsible for the Education of staff, children and interpreters about the importance of attending appointments, there was a high DNA rate, the implications and impact on the health of the child and the cost to the NHS in wasted appointments and sorting out further follow up appointments.

When completing new patient health checks it was important to be aware of additional screening where appropriate. Questions such as;

  • Do they look well, thin, pale, anxious, agitated?
  • Look at body language, do they make eye contact,
  • Are there appropriate interactions between us and staff?
  • Ask if they want help with anything?

Be aware of ‘hidden’ conditions, because of cultural beliefs or shame, they may be afraid and give an atypical history or ‘hide’ symptoms and be not sure who to tell what to.
It was like doing a jigsaw to get a complete picture.

My work also involved dealing with their day to day health needs of the young person. We had to explain to UASC’s what is ‘normal’ in this country, advising that ‘everyone here has these injections’, ‘it is normal to do these tests with these symptoms’, and we had to help them to understand ‘why’’

In primary care with dispersal there may be only a scattering of UASC’s in many practices. Some of the facilities and support we had will not be available, but each one of these children will potentially have a number of unique needs and risk factors not common in primary care normally that may need addressing. They may feel isolated within the community, different language and culture, not have contact with familiar friends or family. The media and some people’s attitudes may make them feel frightened, threatened and intimidated.

In primary care we can make a difference a smile may open a door to communication to help them share a health concern or need. Take time – I know it’s difficult, and the pressure we are under in primary care – make their appointments at a time when the surgery is quieter. Use all the resources now available to help you and them do the best you can.

The role is constantly evolving around what has been learnt, about the children’s ‘journey’ and the experience gained in caring for UASC’s.  Models of appropriate care and support are being made, not only for them but also for anyone involved in their care. Only in the long term will we see how successful we have been in managing the health and well-being of these children as they integrate into society, grow up and nurture their own children in the future.

This is a human being just like us, who deserves a chance to be healthy, and fulfil their dreams and aspirations, despite a start in life neither you, or I could imagine.

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