Widespread ignorance about the right of asylum seekers to free medical care has sparked fears that the government's plans to see them dispersed around the country could lead to serious long-term health problems.
'Evidence collected by the Refugee Council shows that, even in London, asylum seekers are being turned down for GP services by frontline staff who are confused about their entitlements, ' says Nick Hardwick, chief executive of the Refugee Council.
'The problem is further complicated by the NHS's funding system, which effectively discourages GPs from taking asylum seekers on to their registers.
'With GPs facing financial penalties for permanently registering patients who do not have a record of their immunisations or cervical smear tests, as well as facing added costs of finding interpreters, many are deeply reluctant to register asylum seekers.'
The Immigration and Asylum Act, passed last month, gives the government powers to tell refugees where to live, forcing them out of areas where local authorities are struggling to cope with high numbers of claimants.
Mr Hardwick also says many asylum seekers will find specialist services aimed at them even more difficult to access.
He is concerned they w ill be scattered around the UK, often not in significant numbers in any one area.
'They should not be dispersed in a random fashion, but settled in clusters, where they can find mutual support they need, ' he insists.
Mark Johnson, a reader in primary care at De Montfort University, Leicester, agrees. 'All the expertise on refugee health has been largely based in London until now - there is very little knowledge outside.
'Many GPs do not know what refugees and asylum seekers are entitled to, and I recently came across one health authority in the Midlands asking if they were allowed legally to treat them.'
The British Medical Association adds that, in order to cope with particular health needs, a clear infrastructure needs to be in place.
This should include interpreting facilities, local refugee community groups to whom the doctor can refer asylum-seeking patients for extra social support, training for doctors to familiarise themselves with the characteristics of cultural and religious groups, and advice for doctors who will be treating asylum seekers.
'At the very least, the government must ascertain the capacity of health authorities and specialist health services in the areas in which it plans to disperse asylum seekers and ensure sufficient funds have been ring-fenced to provide for them, ' says Michael Wilkes, chair of the BMA's ethics committee.
And he warns: 'The public health departments of port health authorities and of the HAs which currently receive large numbers of asylum seekers have developed screening programmes for infectious disease which may not exist in other areas.'
The King's Fund adds that dispersal will take asylum seekers away from the communities which look after new entrants, promoting social networks and preventing ill- health.
'Community groups support not just health but education, information, cultural activities and housing, ' says a spokesperson.
'They also provide access to food which asylum seekers are used to cooking - a system which may be damaged by the removal of cash benefits.'
The Medical Foundation for the Care of Victims of Torture is campaigning to prevent survivors of torture or asylum seekers with other special needs from being dispersed until areas have been identified with the capacity to deal with them.
'But survivors of torture can be difficult to identify as, characteristically, they do not disclose they are torture victims at the first interview so, before you know it, they will be out of London, ' says Alex Sklar, the foundation's director of clinical services.
'In the regions where they have rarely encountered refugees and asylum seekers before they will have very little idea of what to do.'
The Refugee Council has launched an information service to help health service and local authority professionals to identify the specialist needs of asylum seekers and what they are entitled to. 0171-820 3042.
The Health of Refugees. The King's Fund guide. 0171-307 2591.£5.99
Act now: how the new system will work Under the Immigration and Asylum Act, responsibility for new claims for support by asylum seekers will transfer from the Benefits Agency and local authority social services departments to the Home Office in April 2000.
The new arrangements will involve the dispersal of asylum seekers around the UK. But voluntary interim arrangements to disperse asylum seekers from London and the SouthEast, where local authorities are under 'severe strain', started this week, according to the Home Office.
Co-ordinated by the Local Government Association, clearing houses have been set up in London and Kent to disperse all new asylum seekers to nine regional consortia in the North-West, East Midlands, South Central, Yorkshire and Humberside, North-East, East Anglia, West Midlands, South-West and Wales.
Scotland and Northern Ireland are not included in the interim arrangements as pressure from asylum seekers is far less in those areas. Eventually, the clearing houses are expected to disperse around 2,500 asylum seekers per month, depending on the number of new arrivals. Allocations will be made 'on a demand and supply basis, to match the needs of incoming asylum seekers to the accommodation and support services available. . . within the regional consortia', says an LGA spokesperson.