Abstract

BACKGROUND: The COVID-19 pandemic has prompted considerable changes in delivery of UK primary care, including rapid digitalisation, yet the impact upon marginalised migrant groups is unknown. AIM: To understand the impact of the COVID-19 pandemic on migrants and their access to primary healthcare, and implications for COVID-19 vaccine roll out. DESIGN AND SETTING: Primary care professionals, administrative staff, and migrants (foreign born; >18 years; <10 years in UK), were recruited in three phases using purposive, convenience and snowball sampling from urban, suburban and rural settings. METHODS: In-depth semi-structured interviews were conducted by telephone. Data were analysed iteratively, informed by thematic analysis. RESULTS: 64 clinicians were recruited in Phase 1 (25 GPs, 15 nurses, 7 HCAs, 1 Pharmacist); Phase 2 comprised 16 administrative staff; and Phase 3, 17 migrants (88% asylum seekers; 65% female; mean time in UK 4 years). Digitalisation has amplified existing inequalities in access to healthcare for many migrants due to lack of digital literacy and access to technology, compounded by language barriers and challenges building trust. Participants highlighted challenges registering and accessing healthcare due to physical closure of surgeries. Migrants reported specific beliefs around COVID-19 and COVID-19 vaccines, from acceptance to mistrust, often influenced by misinformation. Innovative opportunities suggested included translated digital health advice using text templates and YouTube. CONCLUSION: Migrants risk digital exclusion and may need targeted support to access services. Solutions are urgently needed to address vaccine hesitancy and barriers to vaccination in marginalised groups (including migrants) to ensure equitable uptake of the COVID-19 vaccine.