title: The impact of direct provision accommodation for asylum seekers on organisation and delivery of local primary care and social care services: a case study.
abstract: BACKGROUND
  Many western countries have policies of dispersal and direct provision accommodation (state-funded accommodation in an institutional centre) for asylum seekers. Most research focuses on its effect on the asylum seeking population. Little is known about the impact of direct provision accommodation on organisation and delivery of local primary care and social care services in the community. The aim of this research is to explore this issue.
  
  
  METHODS
  In 2005 a direct provision accommodation centre was opened in a rural area in Ireland. A retrospective qualitative case study was designed comprising in-depth interviews with 37 relevant stakeholders. Thematic analysis following the principles of framework analysis was applied.
  
  
  RESULTS
  There was lack of advance notification to primary care and social care professionals and the community about the new accommodation centre. This caused anxiety and stress among relevant stakeholders. There was insufficient time to plan and prepare appropriate primary care and social care for the residents, causing a significant strain on service delivery. There was lack of clarity about how primary care and social care needs of the incoming residents were to be addressed. Interdisciplinary support systems developed informally between healthcare professionals. This ensured that residents of the accommodation centre were appropriately cared for.
  
  
  CONCLUSIONS
  Direct provision accommodation impacts on the organisation and delivery of local primary care and social care services. There needs to be sufficient advance notification and inter-agency, inter-professional dialogue to manage this. Primary care and social care professionals working with asylum seekers should have access to training to enhance their skills for working in cross-cultural consultations.
authors.affiliation: Discipline of General Practice, National University of Ireland, Galway.
authors.forename: Hans-Olaf
authors.initials: HO
authors.lastname: Pieper
authors.forename: Pauline
authors.initials: P
authors.lastname: Clerkin
authors.forename: Anne
authors.initials: A
authors.lastname: MacFarlane
mesh_terms: D003142:Communication; D003695:Delivery of Health Care / Q000458:organization & administration*; D054242:Emigrants and Immigrants; D006297:Health Services Accessibility; D006801:Humans; D007494:Ireland; D057766:Policy; D011320:Primary Health Care / Q000458:organization & administration*; D012036:Refugees; D012189:Retrospective Studies; D012946:Social Welfare