Article Text

Poor uptake of primary healthcare registration among recent entrants to the UK: a retrospective cohort study
  1. Helen R Stagg1,
  2. Jane Jones2,
  3. Graham Bickler3,
  4. Ibrahim Abubakar1,4
  1. 1TB Section, Respiratory Diseases Department, Health Protection Services, Health Protection Agency, Colindale, UK
  2. 2Travel and Migrant Health Section, Respiratory Diseases Department, Health Protection Services, Health Protection Agency, Colindale, UK
  3. 3South East Region, Health Protection Agency, London, UK
  4. 4Norwich Medical School, University of East Anglia, Norwich, UK
  1. Correspondence to Professor Ibrahim Abubakar; ibrahim.abubakar{at}


Objectives Uptake of healthcare among migrants is a complex and controversial topic; there are multiple recognised barriers to accessing primary care. Delays in presentation to healthcare services may result in a greater burden on costly emergency care, as well as increased public health risks. This study aimed to explore some of the factors influencing registration of new entrants with general practitioners (GPs).

Design Retrospective cohort study.

Setting Port health screening at Heathrow and Gatwick airports, primary care.

Participants 252 559 new entrants to the UK, whose entry was documented by the port health tuberculosis screening processes at Heathrow and Gatwick. 191 had insufficient information for record linkage.

Primary outcome measure Registration with a GP practice within the UK, as measured through record linkage with the Personal Demographics Service (PDS) database.

Results Only 32.5% of 252 368 individuals were linked to the PDS, suggesting low levels of registration in the study population. Women were more likely to register than men, with a RR ratio of 1.44 (95% CI 1.41 to 1.46). Compared with those from Europe, individuals of nationalities from the Americas (0.43 (0.39 to 0.47)) and Africa (0.74 (0.69 to 0.79)) were less likely to register. Similarly, students (0.83 (0.81 to 0.85)), long-stay visitors (0.82 (0.77 to 0.87)) and asylum seekers (0.46 (0.42 to 0.51)) were less likely to register with a GP than other migrant groups.

Conclusions Levels of registration with GPs within this selected group of new entrants, as measured through record linkage, are low. Migrant groups with the lowest proportion registered are likely to be those with the highest health needs. The UK would benefit from a targeted approach to identify the migrants least likely to register for healthcare and to promote access among both users and service providers.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:


  • To cite: Stagg HR, Jones J, Bickler G, et al. Poor uptake of primary healthcare registration among recent entrants to the UK: a retrospective cohort study. BMJ Open 2012;2:e001453. doi:10.1136/bmjopen-2012-001453

  • Contributors HRS and IA designed the study. The Demographics Batch Service undertook the matching of records via the Health Protection Agency. HRS carried out the analysis and wrote the manuscript, with input from all authors. All authors, external and internal, had full access to all the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. IA is the guarantor of this work.

  • Funding All the authors are funded by the Health Protection Agency. IA and HRS are partly funded by the National Institute for Health Research.

  • Competing interests None.

  • Ethics approval Ethical approval was not required, as the Health Protection Agency has National Information Governance Board approval to hold and analyse national surveillance data for public health purposes under Section 251 of the NHS Act 2006.

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

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.