BackgroundAsylum seekers and refugees (ASR) face difficulty accessing health care in host countries. In 2017, NHS charges for overseas visitors were extended to include some community care for refused asylum seekers. There is growing concern that this will increase access difficulties, but no recent research has documented the lived experiences of ASR accessing UK primary health care.AimTo examine ASR experiences accessing primary health care in the UK in 2018.Design and settingThis was a qualitative community-based study. ASR were recruited by criterion-based sampling through voluntary community organisations.MethodA total of 18 ASR completed face-to-face semi-structured recorded interviews discussing primary care access. Transcripts underwent thematic analysis by three researchers using Penchansky and Thomas’s modified theory of access.ResultsThe qualitative data show that participants found primary care services difficult to navigate and negotiate. Dominant themes included language barriers and inadequate interpretation services; lack of awareness of the structure and function of the NHS; difficulty meeting the costs of dental care, prescription fees, and transport to appointments; and the perception of discrimination relating to race, religion, and immigration status.ConclusionBy centralising the voices of ASR and illustrating the negative consequences of poor healthcare access, this article urges consideration of how access to primary care in the UK can be enhanced for often marginalised individuals with complex needs.

Frailty has recently emerged as a dominant concept against a backdrop of media and governmental narratives that frame the growing ageing population as an economic threat to the current configuration of health care in the United Kingdom (UK). Despite frailty's popularity amongst geriatricians and policy makers, the concept faces resistance from other health-care professionals and older people themselves. This paper draws on the Foucauldian idea of biopower; by suggesting that the contemporary emergence and utilisation of frailty represents a biopolitical practice a number or critical observations are made. First, despite biomedical experts acknowledging ambiguities in the definition of frailty, the concept is presented as a truth discourse. This is driven by the ability of frailty measurements to predict risk of costly adverse outcomes; the capability of frailty scores to enumerate complex needs; and the scientific legitimacy frailty affords to geriatric medicine. Consequently, frailty has become pervasive, knowable and measurable. Second, the routine delineation between frail and robust objectifies older people, and can be said to benefit those making the diagnosis over those being labelled frail, with the latter becoming disempowered. Last, studies show that frailty is associated with increasing wealth inequalities in the UK; however, experts’ suggested management of frailty shifts the focus of responsibility away from ideologically driven structural inequalities towards the frail older person, attempting to encourage individuals to modify lifestyle choices. This neglects the association between lifestyle opportunities and socio-economic deprivation, and the impact of long-term poverty on health. These observations, set against the contemporary political climate of economic austerity, cuts to public services and rationalisation of health resources, bring the urgency of a critical consideration of frailty to the fore.

Background With the aim of decreasing immigration, the British government extended charging for healthcare in England for certain migrants in 2017. There is concern these policies amplify the barriers to healthcare already faced by asylum seekers and refugees (ASRs). Awareness has been shown to be fundamental to access. This article jointly explores (i) health care professionals’ (HCPs) awareness of migrants’ eligibility for healthcare, and (ii) ASRs’ awareness of health services. Methods Mixed methods were used. Quantitative survey data explored HCPs’ awareness of migrants’ eligibility to healthcare after the extension of charging regulations. Qualitative data from semi-structured interviews with ASRs were analyzed thematically using Saurman’s domains of awareness as a framework. Results In total 514 HCPs responded to the survey. Significant gaps in HCPs’ awareness of definitions, entitlements and charging regulations were identified. 80% of HCP respondents were not confident defining the immigration categories upon which eligibility for care rests. Only a small minority (6%) reported both awareness and understanding of the charging regulations. In parallel, the 18 ASRs interviewed had poor awareness of their eligibility for free National Health Service care and suitability for particular services. This was compounded by language difficulties, social isolation, frequent asylum dispersal accommodation moves, and poverty. Conclusion This study identifies significant confusion amongst both HCP and ASR concerning eligibility and healthcare access. The consequent negative impact on health is concerning given the contemporary political climate, where eligibility for healthcare depends on immigration status.

We introduce and critique a previously unexamined form of evidencebased activism (EBA): clinician-led evidence-based activism (CLEBA). In recent years funding of, and access to, the UK's National Health Service (NHS) have been depleted through cuts, privatisation, and the reduction of universal healthcare. In these austere and hostile times, the legitimacy of those drawing attention to resultant health inequalities is eroded. One tactic that doctors have adopted while advocating for the delegitimized has been CLEBA: strategic use of clinical authority in the production and mobilization of knowledge for the governance of health issues. To illustrate the concept, we analyse two cases of CLEBA in the NHS in which we have participated. The first resisting cuts and privatisation of the NHS, the second resisting the charging of forced migrants for healthcare. By analysing CLEBA as a tactic, we show how doctors work to effect progressive goals by lending legitimacy to their allies, who are delegitimised by opponents as 'loony-left', 'shroud-waving' 'health tourists'. This approach to the problem of legitimacy separates CLEBA from EBA. Whereas EBA seeks to rebalance unequal social relations within a doctor-patient collective, CLEBA capitalizes on the symbolic power of doctors to contest unequal social relations out with the collective. By lending clinical authority to activist discourses, CLEBA consolidates forms of collective agency in which certain actors remain illegitimate. In contrast with EBA, where the rebalancing of legitimacy itself is prioritized, CLEBA reinforces a hierarchy of legitimacy that places clinicians on top.