Delivery of interpreting services in UK primary care by population needs: a multisite case study

Interpreting services for patients with no/limited English proficiency are key in healthcare communication and quality of care; yet little evidence exists on interpreting service delivery. This study investigated delivery of interpreting services in UK primary care, particularly how models differ by population needs, and contextual factors impacting delivery.

Four primary care sites were purposively selected to represent a range of population and practice characteristics. 24 episodes/spaces were observed and semistructured interviews were conducted with 22 frontline staff. Data were analysed using the Rapid Research and Evaluation Lab (RREAL) Rapid Assessment Procedure sheets and inductive thematic analysis.

General practices typically fell under three categories of interpreting needs (high, moderate and low), with models and modalities of interpreting delivery designed around these differing needs. High needs practices, with high migrant populations, had on-site interpreting due to impracticalities of arranging per-appointment interpreting and the perception that face-to-face interpreting is the gold standard. In contrast, low needs areas primarily used telephone interpreting due to perceived ease of access, variety of languages and interpreters and mitigating interpreter travel constraints in rural areas. Similarities across sites included using Google Translate as a supporting interpreting tool and the rarity of video interpreting. Frontline staff across sites held similar expectations of interpreters (having knowledge, interpersonal skills and social/cultural acumen) and interpreting service providers (smooth information technology, high standards and language variety). Factors impacting interpreting delivery were needs-specific and cross-cutting. High needs sites experienced resource pressures, 'mop-up' work from secondary care, patients having complex needs and doing extra 'hidden' work such as handling non-medical problems. All sites encountered issues with interpreting delivery systems.

Interpreting services tailored to population needs and primary care priorities are fundamental to delivery of interpreting services. Policy and national guidance should take language need into account and support local contexts to deliver approaches tailored to their needs.