As a multi-site practice in central Liverpool, we had long cared for a small number of refugee and asylum-seeking (RAAS) patients. That changed dramatically in 2022, when a nearby hotel was converted into contingency accommodation for new arrivals. Almost overnight, one of our smaller branches went from zero to 234 registered asylum patients. Across all sites, our RAAS population grew from 159 to 834 within 12 months.

This rapid change highlighted how underprepared we were to meet the needs of this cohort. Barriers emerged immediately: many patients had no ID for registration, language barriers were significant, and there was limited understanding of NHS structures and when to seek different types of care. Patients often presented to primary care with needs that could have been better managed elsewhere. Clinical presentations were complex, spanning both physical and mental health, but with little or no documentation of prior history. The population was transient, with frequent dispersals disrupting continuity of care and delaying referrals. On top of clinical issues, we found ourselves managing significant psychosocial and administrative challenges not typically within a primary care remit.

Most importantly, these patients were extremely vulnerable. Providing the time, empathy and compassion they required simply was not possible within a standard ten-minute appointment.

We recognised the need to work differently. Our first step was education: facilitated learning sessions for staff on the realities of RAAS lives and the sociopolitical context of displacement. We registered as a Safe Surgery, removing ID as a barrier to access, and embedded compassion-focused approaches while also supporting staff around vicarious trauma.

Supporting staff

Evidence shows that vicarious trauma directly correlates with staff burnout, poor morale, mental health struggles and disengagement from roles. It poses a huge risk to us and to our workforce, not only for our Inclusion health teams, but for all primary care team members, as they increasingly care for patients facing complex health issues compounded by psychosocial challenges. 

I obtained a small amount of funding from the practice partners to set up monthly Reflective Practice and Debrief sessions for our Inclusion health teams. These sessions are led by Ste Weatherhead, a clinical neuropsychologist who specialises in trauma informed care, and vicarious trauma, and Saeed Olayiwola, a consultant wellbeing coach.

We have a two hour session to focus on team development and psychological trust and safety at work, case debrief and reflection, developing team and individual resilience and wellbeing practices. We have been doing this for just over six months now, and feedback from our team members has been positive. It takes a lot to be vulnerable in front of colleagues, but all appreciate the time out to reflect and process challenges faced, and to move forward strengthened as a team. I am hoping we can build an evidence bank to support a case for this to be mandated in primary care settings.

Language barriers

To overcome language barriers, we invested in PocketTalk devices, enabling instant two-way translation for registrations, signposting and nurse-led care.

We then restructured access for RAAS patients. With ARRS support, we expanded our MDT to include a RAAS care coordinator, social prescriber and mental health worker. The care coordinator delivered in-house, outreach and ad hoc reviews, providing continuity and support across different settings.

Our most significant innovation has been the introduction of a weekly one-stop RAAS clinic for new patients. Each patient receives:

  • A baseline HCA appointment covering bloods, vaccinations, TB screening and a physical health check.
  • One or two extended GP appointments (up to 50 minutes) for comprehensive review, medication reconciliation, referrals and signposting.
  • Mental health, first contact physio, and drug and alcohol support, as needed.

This model has helped reduce inappropriate demand on acute services, ensured safer prescribing and delivered a more coherent patient journey.

We understood that the health needs of our RAAS patients extend beyond our primary care offer. Collaborative working with community and VCSE partners became essential. We successfully embedded a joint clinic at Liverpool Central Library combining health input with English lessons. We run gardening sessions through the Family Refugee Support Project, building social connection and peer support. Importantly, we coordinated a RAAS-specific safeguarding MDT involving Serco, the Home Office and local agencies to manage care for high-risk patients.

Lived-experience volunteers

Perhaps the most transformative element of our service has been the contribution of lived-experience volunteers. Alongside our amazing care coordinator, Farida—herself a refugee from Pakistan—we now have six volunteers from diverse backgrounds, collectively speaking seven languages. Magda worked for the Ministry of Welfare and Development in Sudan before arriving in Liverpool. Btool and Hilal are qualified doctors from Syria, now supporting patients with clinical understanding and cultural context. Hussni is a dentist, and Mjogan and Amina provide essential insights into local community resources and support.

Their presence has been invaluable in providing in-house interpretation, educating patients on navigating the NHS and signposting to community and legal resources. We have always felt that our team needs to reflect the population we serve, and these volunteers have enabled us to embed this in our work. More than practical help and advice, the presence of lived-experience volunteers mean our vulnerable RAAS patients feel seen, validated and understood. They are able to make meaningful connection, and evidence shows that connection can be more important for physical and mental health than anything we can prescribe within our clinic, or offer through NHS work.

We have since employed two volunteers in administrative roles, and another has progressed to a master’s degree. We are immensely proud of these achievements.

The number of refugees and asylum seekers in Liverpool—and across the UK—continues to rise. Our experience has shown that their needs cannot be met within standard models of primary care. What is required is person-centred, multi-sector, empathetic care from the point of arrival, co-designed with people who have lived experience. Future commissioning must move beyond siloed services towards integrated, innovative models that bring together the NHS, social care, and community organisations. Only then can we provide care that is both clinically effective and truly compassionate for this vulnerable population.

Dr Beth Lynch is a new member of the Pulse PCN editorial board and a GP Partner and clinical director at Brownlow Health PCN, Liverpool. She previously served as the LTC lead for Liverpool Place and as Integrated Care Lead at Network level, with a focus on Health Inequalities and Complex Lives. She also acts as a Medical Advisor for CoppaFeel!, the breast cancer awareness charity.