Case study summary
The NHS is acutely aware that more needs to be done to address health inequalities within our society. The COVID-19 pandemic has emphasised the steps that need to be taken to make healthcare more accessible and inclusive to vulnerable communities.
Federated4Health, Haringey’s GP Federation in North London, is just one example of primary care and other health and social care organisations working together to combat homelessness in their local area.
In response to the COVID-19 pandemic, the federation was commissioned to provide primary care support to patients experiencing homelessness and rough sleeping; many of whom were being emergency housed in hotels, hostels and accommodation sites by local councils. It was recognised that, for people experiencing homelessness, there were higher risks for contracting COVID-19 and developing complications due to their underlying health conditions (although these are often undiagnosed).
Dr Seema Pattni, a GP working for the federation, set up the primary care Haringey Homeless Health Inclusion service to help address some of these issues and to improve access to mainstream primary care services for people experiencing homelessness.
The Haringey Homeless Health Inclusion team (HHHIT) consists of a GP, paramedic and care navigators, as well as operational managers. Together, this team works to improve GP registration amongst homeless communities. Many people experiencing homelessness are not registered with a GP practice, or don’t know the benefits that being registered brings to their health and wellbeing. The HHHIT makes routine visits, called an ‘outreach service’, three times a week to the sites offering emergency accommodation, to educate about GP registration and the services available through general practice. They also identifying any immediate healthcare needs each person may have and put steps in place for these needs to be met. The team provides a holistic health and wellbeing review to temporary residents, often identifying areas where additional services are required, for example relating to exercise, reducing isolation, learning support, dental care, eye care and general wellbeing. The care navigator then helps each person to access the care they need, such as setting up appointments. Every effort is made to empower the patient to subsequently and confidently access mainstream primary care.
The team strives to collaborate and integrate its work with allied agencies involved in patients’ care such as social services, mental health, substance and alcohol misuse, housing related support and street outreach workers. The team has also tried to support the wider agencies that it works with by providing information about GP surgery locations and contact details and how to register there. If barriers are re-encountered for registration or access to care, the team works with the patient and GP practice to resolve these issues.
The team also meets virtually each week with staff from across the health and social care system and housing related support, to discuss patients who have been identified as requiring additional or multi-agency support. These multidisciplinary team (MDT) meetings enable colleagues to provide streamlined and patient-centred care, assessing each individual using a holistic approach. If someone is identified as having a particular problem outside the health and care remit, for example developing language skills, these can also be addressed within the MDT meeting – the work of the care navigator here is to help the patient navigate through multiple services and systems.
The federation has worked with local GPs to provide COVID-19 vaccinations to people experiencing homelessness. This has been done at community hub sites, pop-up sites and during visits to the emergency accommodation.
Targeted staff training
Within the federation, the primary care HHHIT also runs training events for their staff on homelessness. This includes hosting a webinar on GP registration aimed at GP receptionists, in collaboration with Doctors of the World, to discuss the importance of inclusion and GP registration, exploring common barriers to healthcare and the universal right to GP registration for patients experiencing homelessness. Another webinar focused on inclusion health and aimed at clinicians, covers common conditions that people who experience homelessness encounter and provides advice on how to optimise care for such patients in mainstream primary care.
Support staff working with service users have commented that the “HHHIT significantly improved the access to primary care and holistic health assessments and healthcare for vulnerable and homeless people in Haringey”. Feedback from patients who accessed help via the HHHIT outreach service has been positive and they have been grateful for the support, referrals and physical check-ups that they received.
For more information, visit The Federated4Health Portal for Haringey Practices.