Table 4.

Key barriers and identified solutions

Domain	Key finding	Solutions for primary care
New and exacerbated barriers to health care	Increased use of technology	Use multiple modes of translated communications in combination, for example, text, emails, and leaflets Facilitation of virtual group consultations for patients with a specific condition, with a translator Option for the patient to send a written electronic message requesting a consultation and interpreter, and for GP to contact to follow-up within 24 hours (for example, by using eConsult)
	Socioeconomic challenges	Use social prescribers and broad multidisciplinary working, including the third sector Targeted access slots, for example, saved on-the-day appointments for marginalised patients or shift workers Service information or location sharing, for example, vouchers for food banks and virtual leaflets linking migrants to third-sector organisations addressing areas of need
	Communication barriers	Funding of translators and migrant community volunteers and champions Working with local media and communication hubs to deliver COVID-19 health information
	Trust, authority, and information	Relationship building from registration, for example, a new-migrant patient health check Targeted information through local leaders, social media, and traditional means, such as posters and flyers, about the NHS, links between health and immigration services including information-sharing about immigration status, COVID-19, and pandemic-related system changes
	‘One-size-fits-all’ approach	Be flexible in bringing patients in, requesting patients attend the practice for a face-to-face consultation if no other method of communication is possible or effective Widespread diversity training and ‘migrant-friendly’ practices, for example, using the Safe Surgeries scheme^a

Key risk factors for health and COVID-19 vaccine roll-out	Challenges identifying migrants	Effective coding of country of origin, language, and ethnicity to enable identification when patients register with a practice
	Migrants have more risk factors for COVID-19	Integrated ‘one-stop shop’ screening and new-migrant patient health checks
	Challenges decision making about the COVID-19 vaccine	Outreach to local leaders to support community decision making around the vaccine
	Beliefs about COVID-19 and the COVID-19 vaccine	Seek to understand the perspective of local migrant communities, for example, through patient champions and patient participation groups, and distribute accurate, translated information

Opportunities and solutions to improve access to primary care	New technology for service delivery	New models, such as virtual group consultations, use of tailored translated texts, and text templates (for example, using accuRx to send translated screening invitations) to encourage access from marginalised groups
	Codesign of new models	Encourage involvement throughout service design, including proportionate representation in patient participation groups, trials, and information campaigns
	Specialist input across a group of practices	Clinical commissioning group or primary care network funding of specialist support services, for example, through a local enhanced service

↵a The Safe Surgeries initiative is run by Doctors of the World. A Safe Surgery is any GP practice that commits to taking steps to tackle the barriers faced by many migrants in accessing health care.