Arrivals From Ukraine: Advice for Primary Care

Overview

This Guidelines summary is intended to help primary care professionals assess and address the health needs of patients ordinarily resident in Ukraine who have arrived in the UK in response to the conflict between Ukraine and Russia. Arrivals will usually be under the government visa schemes (Ukraine Family Scheme and the Ukraine Sponsorship Scheme [Homes for Ukraine]).

For a full set of recommendations and information, including recommendations on culture, spirituality, and religion, refer to the full guideline.

Access to NHS Care

• Soon after individuals and their families arrive in the UK from Ukraine, they should be supported to register with a GP practice and attend a new patient consultation to assess their health and care needs
• People ordinarily resident in Ukraine who have legal status in the UK have the same entitlements to NHS care as UK residents. However, individuals may not know how the NHS works
• Explain to individuals:
  • how the NHS works, and that everyone who is ordinarily resident in Ukraine—and their immediate family members—who are lawfully in the UK can access NHS care in England for free
  • that some services still incur charges, like prescriptions, dentistry, and optometry—individuals may be eligible for reduced charges or free care for these services, and information about this is available in other languages
  • that they do not need proof of identity or address to register with GP practices (although it helps to ensure their registration is processed accurately if they can provide this)—registration should not be denied for those without identification
  • how and when to access NHS 111, urgent care, and A&E, including when and how to use 999
  • that the capacity of dental services will vary—support them to find an NHS dentist to attend regular dental checkups (rather than waiting until dental issues appear); if urgent dental help is needed, they can call 111
  • how to access vision and hearing services, and support them to access these services where needed
  • how to request an interpreter for healthcare appointments
• Encourage participation in and support access to NHS screening programmes
• Provide individuals with translated COVID-19 testing, vaccination, treatment, and public health restrictions guidance in their preferred language—information about vaccination is also available in Russian
• The GMS1 GP registration form is now available in Ukrainian and Russian.

New Patient Health Check Additional Considerations

• It will be helpful to offer the new patient consultation as early as possible following registration in order to identify and manage their health and care needs, taking into account the individuals’ needs and preferences
• Checklists can be used to aid in assessing new migrant patients, including checklists about children’s health, about oral and dental health, and information about women’s health.

Language

• Offer a professional interpreter to all individuals who experience language barriers, unless in an emergency situation
• It is not appropriate to use family members or friends as interpreters, as there is a high risk of misinterpretation, breach of confidentiality, and safeguarding concerns
• Children should not be used as interpreters
• Mobile phone translation apps are not recommended, as these cannot be relied on to accurately interpret health-related information
• Translated materials are being developed for common healthcare conditions. If producing documents locally, consider producing them in Easy Read format so they are accessible to all, or at least ensure that any original text is in plain English to support those with poor literacy who can read English
• Your local commissioning group should be able to help if you are unsure about the availability of interpreting and translation services in your area, or how to access them.

Contraception and Abortion

• Appropriate use of contraception should be encouraged
• Advise patients that these services are free to all and include male contraceptives, for example vasectomy.

Mental Health

• Escaping war will contribute to psychological stress and mental health issues (for example, post-traumatic stress disorder), which may not manifest until weeks after displacement. Children may be particularly vulnerable, and health partners should utilise the free Psychological First Aid Training package aimed at supporting children and young people
• It is crucial to:
  • recognise that the context of mental health support in Ukraine is likely to have an impact on the levels of stigma about mental health problems and nervousness about accessing help
  • assess individuals’ mental health and wellbeing, as those affected by war and conflict are at higher risk of mental disorders
  • use trauma-informed approaches to care, recognising where people are affected by trauma and responding in a way that prevents further harm and supports recovery
  • refer, where appropriate, to specialist services through the Improving Access to Psychological Therapies service or local voluntary-sector service providers.

Communicable Diseases

Vaccination

• Individuals should be informed that vaccination is free in England
• Assume that patients aren’t immunised unless they can give a reliable history of vaccination and have vaccination records
• Be advised that individuals who arrive in the UK partway through their immunisation schedule should be transferred onto the UK vaccination schedule and immunised as appropriate for their age
• If a course of immunisation has been started but not completed, continue from where it was interrupted. There is no need to repeat doses or restart the course
• See the immunisation algorithm for advice on immunising individuals with uncertain or incomplete immunisation status
• Plan the catch-up immunisation schedule with minimum number of visits and within a minimum possible timescale—aim to protect individuals in the shortest time possible
• All people coming to the UK from Ukraine should be shown the moved to the UK: migrant immunisation leaflet. Paper copies are also available to order.

COVID-19

• Check an individual’s COVID-19 vaccination status. All individuals aged 12 years and above are eligible for the COVID-19 vaccination, as well as those aged 5–11 years who are in a risk group or live with someone with a weakened immune system
• From April 2022, everyone aged 5 years and above is eligible. If the individual is unvaccinated or requires further vaccine doses, support and encourage the individuals to access vaccination as soon as possible, either through local invitation or by booking an appointment through the National Booking Service, calling 119 for free (once registered with a GP), or attending a walk-in vaccination site
• This guidance sets out the vaccine types and doses which should be offered if an individual has had one or more doses abroad. Once registered with a GP, people can also make appointments at a vaccination centre to have their overseas vaccination dose(s) recorded in their medical record (separate to an appointment for vaccination)—see NHS for more information.

Tuberculosis

• The UK Health Security Agency (UKHSA) recommends that those arriving from the Ukraine should have screening for active tuberculosis (TB) as outlined within the previous pre-entry specifications. For children over 11 years and (non-pregnant) adults, this would include: symptom check, chest X-ray, and where appropriate (person is coughing and able to produce sputum) a sputum assessment
• For pregnant women, offer a symptom check and a sputum examination
• If the person has symptoms or an abnormal X-ray, refer for appropriate assessment and investigation
• The current rates of TB in Ukraine mean that universal latent TB infection (LTBI) screening for people arriving from Ukraine is not recommended
• Some commissioning areas within the UK commission a local LTBI screening service for anyone arriving from a country with an incidence of over 40 per 100,000, in line with NICE Guideline 33. The incidence of TB in Ukraine is above this threshold, therefore, arrivals from Ukraine in these areas would receive LTBI screening as part of local arrangements
• Offer vaccination against TB for those aged under 16 years who do not have a history of Bacillus Calmette–Guérin (BCG) vaccination and are tuberculin-negative, including infants under the age of 1 year
• It is also important to maintain long-term vigilance for symptoms of TB within these populations, even if the initial screening is negative
• Emphasise that if a patient tests positive, treatment is free and most treatment can be provided on an outpatient basis
• For more information on TB, see the Migrant Health Guide on tuberculosis.

Hepatitis B

• Arrange screening for pregnant women and ensure post-exposure immunisation is provided to infants born to hepatitis B-infected mothers
• Hepatitis B vaccine should be offered to family members and close contacts of confirmed cases
• For more information on hepatitis B, see the Migrant Health Guide on hepatitis B.

Hepatitis C

• Offer screening for hepatitis C to all adults
• For more information on hepatitis C, see the Migrant Health Guide on hepatitis C.

Typhoid

• Consider enteric fever in the differential diagnosis of any illness following arrival into the UK. Severity of disease is variable, although most individuals experience fever and headache
• For more information on typhoid infection, see the Migrant Health Guide on enteric fevers.

Polio

• Due to vulnerability to polio, it is important to establish vaccination history and, if the individual is unvaccinated or requires further vaccine doses, arrange vaccinations as soon as possible. If there is any doubt about vaccination status, offer an additional dose
• For more information on polio, see the Migrant Health Guide on polio.

Measles

• If the individual is unvaccinated or requires further vaccine doses, vaccinate them as soon as possible
• If there is any doubt about vaccination status, offer an additional dose
• Due to the current refugee situation, consider measles as a differential diagnosis for anyone in this population presenting with fever and rash illness
• For more information on measles, see the UKHSA webpage on measles: guidance, data, and analysis.

Sexually Transmitted Diseases and HIV

• All new arrivals should be offered an HIV test
• Take a sexual history, and screen for sexually transmitted infections (STIs) and HIV according to risk, as specified in the UK national standards and guidelines. Offer all sexually active patients under the age of 25 testing for chlamydia, gonorrhoea, and syphilis
• For more information, see guidance on STIs and HIV.

Antimicrobial Resistance

• If clinically appropriate, consider sending microbiological specimens early before initiating antimicrobial treatment, for example, for urinary tract infections, particularly where first-line empiric treatment has already been given and has failed.

Nutritional and Metabolic Concerns

Anaemia

• Be alert to the possibility of anaemia in entrants to the UK from Ukraine, particularly women and pre-school children
• Test as clinically indicated.

Vitamin D

• Consider the possibility of vitamin D deficiency in people who may be at risk due to:
  • darker skin
  • not spending much time outdoors
  • covering up most of their skin when outdoors.

Vitamin A

• Where you suspect vitamin A deficiency, seek advice on appropriate diagnosis and management from your local endocrinology or paediatric team
• Consider supplementation of vitamins A, C, and D for all infants and children aged 6 months to 5 years old, in line with UK government recommendations.

Iodine

• Consider any thyroid disorders as a result of iodine deficiency and seek expert endocrinological advice as necessary.

Noncommunicable Diseases

• Consider offering NHS health checks, particularly to adults aged 40 years and over, to detect cardiovascular disease. Refer individuals to appropriate support for help with smoking cessation, alcohol dependence, nutrition, and physical activity.

Women’s and Maternal Health 

• Refer all pregnant women to maternity services and explain the antenatal and postnatal care system in the UK
• Ensure all pregnant women are offered routine screening for infectious diseases (HIV, hepatitis B, and syphilis). Note that HIV rates in Ukraine are higher than in in the UK. Consider screening pregnant women for hepatitis C due to prevalence in Ukraine
• Ensure individuals are aware of the risks associated with alcohol consumption in pregnancy and refer to local support services where appropriate
• Midwives and maternity staff should refer to the Royal College of Midwives guide to caring for vulnerable migrant women
• For further information and resources on women’s health, visit Women’s Health: Migrant Health Guide.

Child Health

• Please refer for child health and development services on registration.

Safeguarding

• Assess for any safeguarding concerns and take appropriate actions to prevent harm, following local safeguarding procedures. People fleeing violence may be at risk of domestic violence, modern slavery, and domestic abuse
• Consider asking about experience of and risk of sexual and gender-based violence. Refer to the NHS safeguarding policy and the NHS safeguarding app for more information
• Safeguarding referrals for adults and/or children must follow usual local processes irrespective of immigration status. Local safeguarding professionals are a vital source of advice and support for any concerns.

Further Information and Useful Links

• Visit the Migrant Health Guide for more information on a range of migrant health topics
• Vulnerability and Trauma Informed All Our Health chapter
• Inclusion Health: applying All Our Health
• Inclusion Health Self Assessment Tool for Primary Care Networks
• Refugee Council information, facts and guides
• Doctors of the World resources including toolkits and translated resources.