With homeless people attending A&E five times more frequently than the rest of the population, homelessness is commonly associated with complex health needs and premature death.
And yet, accessing GP services is often a real challenge for homeless people, with thousands having little to no access to primary care surgeries.
Often, homeless people don’t seek medical help until it’s an emergency, resulting in escalating health problems that could have been easier to resolve if identified sooner.
Why are so many homeless people struggling to access primary care services?
Of those who are registered with a GP or dental survey, many are refused access to the support they need. This is despite the Health and Social Care Act 2012 stating that the NHS must “have regard to the need to reduce inequalities”.
Refusal of access can sometimes be due to lateness, missed appointments or disruptive behaviour within the surgery. There have also been cases where homeless people have been refused access due to a lack of identification or proof of address.
Many practices require that new patients provide various forms of identification during the registration process. This alone can prevent homeless people from seeking help in the first place, particularly if they have friends who feel they’ve been turned away or let down by the system.
How Cambridge Access Surgery is helping
IMH’s Cambridge Access Surgery is a clinic created exclusively for homeless people rather than the general public.
In addition to having a dedicated surgery for homeless people who feel unwell or need medical attention, the surgery team also do outreach work within busy homeless areas and local shelters such as Jimmy’s Shelter and Winter Comforts. Nurses will often volunteer to go out in the early hours of the morning unpaid. Not only do they spend outreach time raising awareness of the shelter amongst those most vulnerable and encouraging them to register with the surgery, they also seek to vaccinate patients against influenza by attending the shelters to hold flu clinics.
A commitment to safety
Earlier this year Cambridge Access Surgery was inspected by the Care Quality Commission (CQC) and the comprehensive analysis deemed the service to be ‘outstanding’.
The practice demonstrated strong clinical leadership abilities along with a dedication to cohesive team working.
The CQC’s report says: “There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
“The practice had clearly defined and embedded systems to minimise risks to patient safety. A risk calendar has been created to monitor when risk assessments were due.”
Professor Steve Field, Chief Inspector of General Practice said of the surgery: “Staff knew their population well and would phone the outreach team to check on patients if they had not been to the practice for a period of time. When patients were admitted to hospital, the practice checked they had essential personal belongings.”
Yvonne Ellis, Cambridge Access Surgery’s Practice Manager said: “Receiving an “Outstanding” rating from the Care Quality Commission reflects the actual “Team” work we do at Cambridge Access Surgery.
“I feel that the main contributing factor to this is “Communication”. Be it with patients, peers or other agencies alike. Through excellent communication we are able to work closely as a team enabling everyone to understand the role they have in ensuring the smooth running of the practice and the safety and welfare of patients and staff.
“Achieving “Outstanding” has made us even stronger as a team with the hunger to strive to do even more for the vulnerable patients we treat.”
A human approach
Overlooked by hundreds of passersby on a daily basis, it’s not uncommon for homeless people to feel ignored and dehumanised by those around them. This is why at Cambridge Access Surgery, there’s a real focus on providing a human and friendly approach. The CQC’s inspection reflected this and a survey of those that use the practice’s service reported that most patients would recommend the surgery and felt happy that they’d been treated with care.
Professor Field added: “There was an outstanding caring culture within the practice and we saw many examples. Staff treated all the patients as individuals and patients we spoke with confirmed this.
“We received 27 comment cards from patients. All 27 reported caring, professional, approachable staff.”
Going above and beyond
The CQC report shared evidence of the practice going above and beyond typical surgery expectations. From charging patients’ mobile phones to receiving mail for those with no fixed abode, Cambridge Access Surgery’s services far exceed traditional healthcare.
Professor Field said: “Staff had donated items such as clothing and bedding to the local shelter and provided a lunch once a month at the practice for patients attending the Hepatitis C support group. There was always fruit and biscuits available for patients who wanted them and staff ensured patients enhanced needs were met.
“A common mode of transport for patients was by bicycle which had to be left at the front of the building, so the practice provided bike locks to ensure they were kept safe. Patients were allowed to charge their phones at the practice to ensure they could be contacted when necessary. For those patients with dogs, the practice provided water and shelter for them while the patient was seen by a clinician.”
Catering to patients’ needs
The inspection found that the surgery was willing to offer a flexible service that catered to patients’ needs, rather than the needs of more traditional patients with homes and jobs.
Patients considered unlikely to stick to appointments were encouraged to attend drop-in services at the surgery or local shelter. The surgery also showed a commitment to encouraging and acting upon feedback – good and bad. In the unlikely event that a patient wished to complain, verbal feedback was accepted, eliminating the need for patients to write letters or fill in online complaint forms.