avoid replicating the actions of the trafficker by providing assurances to the victim and then being unprepared when the time comes to take positive action in response to their needs. 7.4 Working with Victims of Trafficking who have Forged Relationships with “Rescuers” or Partners HBF clinicians work with clients who have been “rescued” from trafficking situations by people who have now become their partners, and may have provided them with accommodation. These relationships are often complex. The clinician should be careful not to undermine the relationship unnecessarily unless the client is at risk of harm, however they should remain consistently alert for evidence of continuing exploitation. It is essential that the clinician does not simply assume that they know what is best for the client and instead allows them to arrive at their own conclusions by talking through their feelings in a guided manner. In some cases a relationship may not be ideal due to the specific circumstances of the client, or the behaviour of the “rescuer”, but it may also have some positive aspects for the client. It is good practice to observe the situation over several sessions, give advice and providing the client with the contact details of relevant organizations. The client should be reminded that they can obtain support and assistance if they decide to change their situation at any time because they feel unable to cope. In HBF’s experience, some of these relationships deteriorate after the first few months and may result in situations where the client again suffers psychological abuse and/or domestic violence. For this reason, continued contact with the client from the outset is a primary aim. 7.5 Access to Healthcare Services: the Value of Having an In-house General Practitioner HBF has an in-house general practitioner (GP/UK doctor) who does not treat or prescribe medication for HBF clients, but can assist them and assess their needs without the time restrictions which are encountered in mainstream services. Clients also have the benefit of appropriate interpreters at HBF appointments. A medical consultation at HBF can often help people who are nervous about disclosing traumatic experiences to feel more secure because they are speaking to a doctor about their medical history in an organization that they have come to think of as safe. HBF clients sometimes reveal more to our in-house GP in a medical consultation than in an initial therapy session. This information 94 helps to build a detailed clinical picture. Victims of trafficking who are registered with a UK primary care doctor (GP) can find it very difficult to discuss their trafficking experiences and therefore may not disclose their related physical and psychological injuries. Standard National Health Service (NHS) appointments in the UK are restricted to 10 minute time slots, and often GPs do not use an interpreter, or may rely upon a remote telephone interpretation service. Therefore GPs may attempt to resolve victims’ physical and mental health problems without having any knowledge of the underlying, trafficking-related issues. The in-house GP at HBF works with other clinicians on individual cases. She frequently refers clients to the National Health Service (NHS) and, with their consent, communicates authoritatively with external GPs to inform them of the particular nature of the case, and to recommend appropriate treatment/medication and follow up work on physical and psychological health. Further follow-up sessions with the client help to ensure that HBF’s recommendations have been implemented, and determine whether further discussion is required with the client’s GP. Co-ordination of healthcare services for victims of trafficking After escaping from their trafficking situation, many victims feel they have no choice but to live and work irregularly in order to survive. They are often unaware of their legal rights and may have reason to fear the actions of the authorities (for example being forcibly returned to their country of origin or being detained) if they come forward. Lives lived “underground” consist of socio-economic hardship, destitution and/or the lack of a permanent or safe place to live which can result in further exploitation. They may move around between areas because they have become destitute, or they have no fixed place of residence. Victims of trafficking who are awaiting decisions on legal claims are accommodated in temporary, government- provided housing and may be dispersed at very short notice to different areas of the country. In the frequent cases where victims of trafficking have moved to different areas, there may be no comprehensive, updated medical records of their previous consultations and treatment which can be accessed by a new GP if they are able to register with one. As a result some clients do not receive follow-up information on their test results, diagnoses or treatments and they may not have the language ability or access to necessary interpretation services to follow this up for themselves. In HBF’s experience, victims who are vulnerable because of cultural differences, learning difficulties or responses