Reducing health inequalities for inclusion health groups

Earlier this year, NHS Somerset’s Homeless Health Service won the 2023 NHS Parliamentary Health Equality award, which recognises organisations that work collaboratively to “reduce health inequalities and prevent ill health in their community”. Laura Devlin, an inclusion and homeless health GP, explains how the service works and how the newly published Inclusion Health Framework can support other regions to reduce health inequalities for these vulnerable groups.

The Homeless Health team consists of two inclusion health GPs, myself and Dr Lisa Horman, who work alongside the Somerset Homeless and Rough Sleepers Nursing Service (a 13-person team consisting of nurses, health link workers, peer support workers with lived experience, mental health nurses, and an administrator), overseen by clinical lead Karen George. . The collaborative work of the nursing team and GPs is integral to the success of the team.

Together we provide holistic, person-centred care and open-ended support to those who are experiencing homelessness, as well as people from Gypsy, Roma, and Traveller communities, and vulnerable migrants – all funded by NHS Somerset and Somerset Council.

Our work involves helping people overcome barriers to accessing mainstream healthcare services and providing high-quality healthcare at informal drop-in clinics and through outreach visits.

We try, wherever possible, to go to the person in need, visiting those who are sleeping rough or living in vans, hostels and other forms of temporary accommodation, staying on temporary and permanent Traveller sites, or taking shelter in retreats and refuges.

We receive referrals from our colleagues in the council, the Department of Work and Pensions, hostels, police, schools, charities, village agents, GP surgeries, hospital teams, and drug and alcohol services. We also increasingly receive self-referrals and word of mouth recommendations, and this has been very encouraging.

Collaboration is key

Collaborative working is key to the success of the healthcare we provide. We are very fortunate to work within a large multi-agency team, including our colleagues at The Roost, part of Yeovil Community Church where we offer a weekly healthcare drop-in session. The Roost provides a social drop-in with food and drink, an excellent music room, sports and crafts, showers and laundry facilities, access to a range of professional services, and an adjacent foodbank. The Roost also benefits from having staff members with lived experience of homelessness.

The ability to be flexible and creative in unusual situations is essential. The drop-in model runs without scheduled appointments and allows for extended consultation times. People can bring friends, relatives, support workers, and pets. It is a great privilege to hear a person’s story, and it is vitally important that we have the time and space to gain a greater understanding of who a service user is and how they came to be in their present situation. We build relationships and earn trust, so that we can establish together what, if anything, the person wants to change.

We have been fortunate to have the support of an amazing public health team in Somerset Council. I am extremely grateful to be working alongside talented, compassionate colleagues who share my commitment to improving healthcare for vulnerable people.

A holistic approach

A holistic approach is essential to our practice. We recognise that not every healthcare problem has a medical solution, and we work closely with other agencies to help address issues around housing, finances, social isolation, and relationship concerns, including safeguarding.

I have learned that my most important duty is advocating for my patients. Our team is passionate about social justice and strives to ensure that everyone is treated fairly and with respect. We aim to help excluded people navigate the confusing healthcare system, and to give them the same high-quality care that any person would expect to receive in a GP or hospital setting.

Our challenges and successes

There have been challenges, such as precarious funding; the requirement to provide quantitative data to demonstrate the value of a service for which the number of patients seen means very little compared to the individual person’s experience; tackling stigma; and IT problems.

But there have been major successes too. We have built fruitful relationships with patients, community leaders, and other professionals; made vital diagnoses; improved the management of health conditions, and worked with the council to find safe and suitable housing. We have also supported abstinence; brought patients into contact with other services such as digital inclusion teams and drug and alcohol services; improved data analysis and future service provision by coding in GP and RiO notes; and increased awareness of homelessness and the issues that people from Inclusion Health groups face.

Most of all, I hope we have made people feel cared for.

I really welcome the new NHS England framework for NHS Action on Inclusion Health. I fully support the key principles identified within it which reflect the work we have led in Somerset:

  1. Commit to action
  2. Understand the characteristics and needs of people in inclusion health groups
  3. Develop the workforce for inclusion health
  4. Deliver integrated and accessible services
  5. Demonstrate impact and improvement through action on inclusion health

I hope systems use this framework to plan, develop and improve health services to meet the needs of people in inclusion health groups and narrow the health inequalities gap.

Laura Devlin

Laura Devlin is a general practitioner based in Somerset. She is the GP for Inclusion and Homeless Health in Mendip and Yeovil, and Yeovil PCN lead on reducing health inequalities. Since qualifying as a GP in 2008, Dr Devlin has worked in substance misuse and homeless health services in Glasgow, London, and Somerset.