Primary care receptionists influence migrant access to healthcare by acting as street-level bureaucrats: a scoping review.

Abstract

BACKGROUND: Receptionists in primary care play a pivotal, yet underexplored, role in shaping access to healthcare for migrants. This scoping review applies Lipsky’s theory of street-level bureaucracy to examine if and how frontline administrative staff influence migrant access to primary care and thence to further health services. METHODS: A systematic search was done of seven literature databases, the archives of seven journals, and five websites, following guidance by the Joanna Briggs Institute for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. We synthesised 44 sources – including peer-reviewed studies, grey literature, and newspaper articles – focusing on migrant interactions with UK general practice receptionists. RESULTS: Thematic analysis revealed three dominant themes: receptionists are under-prepared to manage linguistic minorities; receptionists feel like protectors of the system; and receptionists’ choices reflect a wider institutional ethos. Findings suggest that receptionists frequently exercise discretionary power to either obstruct, or more rarely facilitate, migrant access to care. Despite official guidance mandating universal access to primary care, migrants are often informally denied registration when they are eligible for care. Receptionists’ behaviours were deeply influenced by implicit biases, the absence of formal translation resources, and prioritising practice priorities over the clinical needs of patients. However, individual actions seem to be shaped by broader discourse and structural constraints. CONCLUSION: This review highlights how receptionists exercise personal discretion through which migrant health inequalities are reproduced at the point of access. We make concrete recommendations for changes to medical training and practice, based on our results.