Commissioning, Implementation and Policy Perspectives on Interpreting Services in UK Primary Care: A Qualitative Study

Yargawa, Judith; Whitaker, Katriina L.; Hieke, Graham; Vindrola-Padros, Cecilia; Williams, Emily D.; Gill, Paramjit; Islam, Lily; Braun, Sabine; Black, Georgia B.

Commissioning, Implementation and Policy Perspectives on Interpreting Services in UK Primary Care: A Qualitative Study

Articles in Press

Document Type : Original Article

Authors

Judith Yargawa ¹

Katriina L. Whitaker ²

Graham Hieke ²

Cecilia Vindrola-Padros ³

Emily D. Williams ⁴

Paramjit Gill ⁵

Lily Islam ⁶

Sabine Braun ⁷

Georgia B. Black ¹

¹ Wolfson Institute of Population Health, Queen Mary University of London, London, UK

² School of Health Sciences, University of Surrey, Guildford, UK

³ Department of Targeted Intervention, University College London, London, UK

⁴ Faculty of Life Sciences and Medicine, King’s College London, London, UK

⁵ Warwick Applied Health, Warwick Medical School, University of Warwick, Warwick, UK

⁶ Patient and Public Involvement, London, UK

⁷ Centre for Translation Studies, University of Surrey, Guildford, UK

Abstract

Background
Language barriers in primary care contribute to health inequalities, limiting access to services and affecting patient outcomes. Professional interpreting services are emphasised in UK guidance, but evidence on how policy-makers and commissioners deliver these services is lacking. This study aimed to explore the commissioning and implementation of interpreting services in UK primary care from the perspectives of commissioners, policy-makers, interpreters, and interpreting service providers.

Methods
Semi-structured interviews were conducted with 31 participants (12 national policy-makers, 6 commissioners, 7 interpreters, and 6 interpreting service providers). Thematic analysis was conducted to explore delivery and identify best practices and key challenges in delivery.

Results
The study found variation in commissioning models, with some areas favouring large national providers for widened scope and cost efficiency, while others prioritised local interpreting services for higher quality. The UK was seen as world-leading in interpreting provision, however fragmentation, lack of standardisation, accountability gaps, funding constraints within a publicly-funded healthcare system, and varied interpreter competencies and renumeration led to inconsistency in delivery. The healthcare sector was reported as having lower interpreting standards compared with other UK public sectors. Technological solutions were used in delivery and offered key advantages but sometimes failed to meet patient and provider needs.

Conclusion
Strengthening national regulation, funding allocation, and service integration is essential to addressing systemic issues and improving interpreting service delivery in UK primary care. Policy recommendations include promoting “what good looks like,” standardising interpreter qualifications and adopting approaches tailored to local population needs.

Keywords

Interpreting

Language Support

Primary Care

Policy

Qualitative Research

United Kingdom

1. Whitaker KL, Krystallidou D, Williams ED, et al. Understanding uptake and experience of interpreting services in primary care in a South Asian population in the UK. JAMA Netw Open. 2022;5(11):e2244092. doi:10.1001/jamanetworkopen.2022.44092

2. Office for National Statistics (ONS). Language, England and Wales: Census 2021. ONS; 2021. https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/language/bulletins/languageenglandandwales/census2021#:~:text=Additionally%2C%201.5%25%20(880%2C000),not%20speak%20English%20at%20all. Accessed January 2025.

3. Ali PA, Watson R. Language barriers and their impact on provision of care to patients with limited English proficiency: nurses' perspectives. J Clin Nurs. 2018;27(5-6):e1152-e1160. doi:10.1111/jocn.14204

4. Health Services Safety Investigations Body (HSSIB). Interim Report- Clinical Investigation Booking Systems Failures: Written Communications in Community Languages. HSSIB; 2023. https://www.hssib.org.uk/patient-safety-investigations/clinical-investigation-booking-systems-failures-written-communications-in-community-languages/interim-report/. Accessed February 2025.

5. Li S, Pearson D, Escott S. Language barriers within primary care consultations: an increasing challenge needing new solutions. Educ Prim Care. 2010;21(6):385-391. doi:10.1080/14739879.2010.11493944

6. Gill PS, Shankar A, Quirke T, Freemantle N. Access to interpreting services in England: secondary analysis of national data. BMC Public Health. 2009;9:12. doi:10.1186/1471-2458-9-12

7. Gill PS, Beavan J, Calvert M, Freemantle N. The unmet need for interpreting provision in UK primary care. PLoS One. 2011;6(6):e20837. doi:10.1371/journal.pone.0020837

8. Hieke G, Williams ED, Gill P, et al. Uptake and experience of professional interpreting services in primary care in a South Asian population: a national cross-sectional study. BMC Prim Care. 2024;25(1):405. doi:10.1186/s12875-024-02646-4

9. Al Shamsi H, Almutairi AG, Al Mashrafi S, Al Kalbani T. Implications of language barriers for healthcare: a systematic review. Oman Med J. 2020;35(2):e122. doi:10.5001/omj.2020.40

10. Legislation.gov.uk. Equality Act 2010. 2010. https://www.legislation.gov.uk/ukpga/2010/15/contents. Accessed February 2025.

11. NHS England. Guidance for Commissioners: Interpreting and Translation Services in Primary Care. NHS England; 2018. https://www.england.nhs.uk/wp-content/uploads/2018/09/guidance-for-commissioners-interpreting-and-translation-services-in-primary-care.pdf. Accessed 2023.

12. Bansal A, Moore D, Singh D. Consulting through interpreters. InnovAiT. 2015;8(5):306-311. doi:10.1177/1755738015573284

13. Davies A. The Cost of Providing Quality Interpreting. Multilingual; 2016. https://multilingual.com/pdf-issues/2016-01-02.pdf. Accessed February 2025.

14. National Register of Public Service Interpreters (NRPSI). Code of Professional Conduct. NRPSI; 2024. https://www.nrpsi.org.uk/for-clients-of-interpreters/code-of-professional-conduct.html. Accessed March 2024.

15. Chartered Institute of Linguists (CIOL). Professional Code of Conduct. CIOL; 2022. https://www.ciol.org.uk/code. Accessed March 2025.

16. Greenhalgh T, Voisey C, Robb N. Interpreted consultations as 'business as usual'? An analysis of organisational routines in general practices. Sociol Health Illn. 2007;29(6):931-954. doi:10.1111/j.1467-9566.2007.01047.x

17. Department of Health and Social Care (DHSC). Guidance: The NHS Constitution for England. DHSC; 2023. https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england. Accessed March 2025.

18. Legislation.gov.uk. Health and Social Care Act 2012. 2012. https://www.legislation.gov.uk/ukpga/2012/7/contents. Accessed March 2025.

19. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:10.1186/1748-5908-4-50

20. Damschroder LJ, Reardon CM, Widerquist MA, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(1):75. doi:10.1186/s13012-022-01245-0

21. Bryman A. Sampling and selection in qualitative research. Social Research Methods, 4th Edition. Oxford: Oxford University Press; 2012. Cited in Ritchie J, Lewis J, Nicholls CM, Ormston R, Editors. Qualitative research practice: a guide for social science students & researchers, 2nd edition. Los Angeles: SAGE Publications; 2014.

22. Yargawa J, Vindrola-Padros C, Whitaker KL, et al. Delivery of interpreting services in UK primary care by population needs: a multi-site case study. BMJ Public Health. 2025.

23. Vindrola-Padros C, Chisnall G, Cooper S, et al. Carrying out rapid qualitative research during a pandemic: emerging lessons from COVID-19. Qual Health Res. 2020;30(14):2192-2204. doi:10.1177/1049732320951526

24. Jager A, Papoutsi C, Wong G. The usage of data in NHS primary care commissioning: a realist evaluation. BMC Prim Care. 2023;24(1):275. doi:10.1186/s12875-023-02193-4

25. Jager A, Wong G, Papoutsi C, Roberts N. The usage of data in NHS primary care commissioning: a realist review. BMC Med. 2023;21(1):236. doi:10.1186/s12916-023-02949-w

26. Nationalarchives.gov.uk. National Agreement on Arrangements for the Use of Interpreters, Translators and Language Service Professionals in Investigations and Proceedings Within the Criminal Justice System, as Revised 2007. https://webarchive.nationalarchives.gov.uk/ukgwa/20100920144438mp_/http://frontline.cjsonline.gov.uk/_includes/downloads/guidance/race-confidence-justice/National_Agreement_on_Use_of_Interpreters-August_2008.pdf. Accessed September 2025. Published 2007.

27. Nationalarchives.gov.uk. Terms and Conditions for Individuals Providing Face-to-Face Interpreting Services. https://webarchive.nationalarchives.gov.uk/ukgwa/20100920143917mp_/http://www.hmcourts-service.gov.uk/docs/infoabout/interpreters/Interpreters-Standardised-FTFI-Terms-Conditions-(CJS).pdf. Accessed September 2025.

28. Legislation.gov.uk. Directive 2010/64/EU of the European Parliament and of the Council. 2010. https://www.legislation.gov.uk/eudr/2010/64/body. Accessed September 2025.

29. House of Lords Public Services Committee. Lost in Translation? Interpreting Services in the Courts. 2025. https://publications.parliament.uk/pa/ld5901/ldselect/pubserv/87/87.pdf. Accessed September 2025.

30. National Police Chiefs' Council. Police Approved Interpreters & Translators (PAIT) Classifications for Spoken Language and British Sign Language (BSL) Face to Face Interpreters. 2023. https://www.police.uk/SysSiteAssets/police-uk/media/downloads/npls/PAIT-specification-table.pdf. Accessed March 2025.

31. Lehane D, Oliver P, Mitchell C, Burton C. Interpreter costs across clinical commissioning groups in England 2017-2018: a cross sectional survey using 'freedom of information' requests. Br J Gen Pract. 2020;70(Suppl 1):bjgp20X711377. doi:10.3399/bjgp20X711377

32. European Union Agency for Asylum. Asylum Report 2020: 7.4 Interpretation Services. 2020. https://euaa.europa.eu/asylum-report-2020/74-interpretation-services. Accessed March 2025.

33. Irimia M, Kolke T, Cyriac A, et al. Exploring clinicians' awareness of language line and barriers in accessing NHS interpreting services. Future Healthc J. 2024;11:100081. doi:10.1016/j.fhj.2024.100081

34. Rajiv P, Riggs E, Brown S, Szwarc J, Yelland J. Communication interventions to support people with limited English proficiency in healthcare: a systematic review. J Commun Healthc. 2021;14(2):176-187. doi:10.1080/17538068.2021.1890518

35. Joseph C, Garruba M, Melder A. Patient satisfaction of telephone or video interpreter services compared with in-person services: a systematic review. Aust Health Rev. 2018;42(2):168-177. doi:10.1071/ah16195

36. Pruskil S, Fiedler J, Pohontsch NJ, Scherer M. Experiences with remote interpreting tools in primary care settings: a qualitative evaluation of the implementation and usage of remote interpreting tools during a feasibility trial in Germany. BMJ Open. 2023;13(11):e073620. doi:10.1136/bmjopen-2023-073620

37. Ji X, Chow E, Abdelhamid K, et al. Utility of mobile technology in medical interpretation: a literature review of current practices. Patient Educ Couns. 2021;104(9):2137-2145. doi:10.1016/j.pec.2021.02.019

38. Dowbor T, Zerger S, Pedersen C, et al. Shrinking the language accessibility gap: a mixed methods evaluation of telephone interpretation services in a large, diverse urban health care system. Int J Equity Health. 2015;14:83. doi:10.1186/s12939-015-0212-9

39. Jaiteh M, Cormi C, Hannetel L, Mir JP, Leaune E, Sanchez S. Perception of the use of a telephone interpreting service during primary care consultations: a qualitative study with allophone migrants. PLoS One. 2022;17(3):e0264832. doi:10.1371/journal.pone.0264832

40. NHS England. Improvement Framework: Community Language Translation and Interpreting Services. NHS England; 2025. https://www.england.nhs.uk/long-read/improvement-framework-community-language-translation-and-interpreting-services/#:~:text=If%20a%20translation%20is%20inaccurate,people%20with%20limited%20English%20proficiency. Accessed September 2025.

41. Hieke G, Black GB, Yargawa J, et al. South Asian patient experiences of professional interpreting service provision in general practice in England: a qualitative interview study. Int J Equity Health. 2025;24(1):104. doi:10.1186/s12939-025-02477-4

42. Pandey M, Maina RG, Amoyaw J, et al. Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study. BMC Health Serv Res. 2021;21(1):741. doi:10.1186/s12913-021-06750-4

43. Daqiq B, Akramy SA, Barati AM. The impacts of English language proficiency on employment opportunities. Am J Sci Educ Res. 2024;609:1-8. doi:10.47991/2835-6764/ajser-183