3. Enter UVMP
Urban Village Medical Practice is able to offer a unique healthcare service within Manchester to currently 850 homeless people, as well as having a mainstream population of 10,000. In many ways, services offered to homeless people can act as a stress test to the NHS — things start breaking for this group of people first because they are at the bottom of the pile in terms of access to services. Access is the key problem; homeless people have far less ability to access, demand and advocate for their services because they have more chaotic, unstructured lives. UVMP overcomes these problems in three key ways:
- Proactive registration. Despite being based in North Manchester and already having one of the most unhealthy populations in the UK, UVMP also go out of their way to register homeless people where many GPs turn them away. It’s difficult for anyone to sign up at a GP service these days, as one of the ways GPs are stewarding their incredibly stretched resources is to reduce access to them. Unfortunately, this means that the people who already have it easier in accessing medical care — organised people, with structured lives — get a bigger slice of the pie, because it’s people like the homeless who then get reduced access. So a practice that deliberately looks to give homeless people preferential access, for example by not requiring proof of address and inviting people specifically to register, helps to improve the healthcare homeless people get.
- Putting everything in one place. UVMP invites homeless people through the door, and then invites them back as often as possible, by offering loads of services in the same building. It becomes a familiar, trusted place that homeless people make the journey to regularly, to get their leg ulcers dressed, see the drugs workers, pick up prescriptions, go to the drop in clinics (drop in is key — appointments don’t work if you don’t know the time and often don’t wake until afternoon). UVMP have a dedicated homeless team who do case management — looking out for individual people experiencing homelessness and trying to get them into the practice, into accommodation, and accessing other services they can benefit from. A one-stop-shop makes a huge difference to simplifying the process of accessing services. It’s still not enough in the face of chaos, and homeless people have poor engagement and attendance, but it’s a lot better than what would be there otherwise. UVMP regularly reengages patients who haven’t seen a doctor for years, despite significant medical problems.
- The hospital in-reach team. This is a service operated by the practice 5 days a week, where a GP and case worker go into hospital every morning to assess all homeless patients in hospital. They check for any patients who are No Fixed Abode or in any of the 35 hostels in Manchester on their lists and see them on the wards to input into their care. They ensure they are actively registered with a GP they can see, ensure their discharge will be safe (and won’t result in an immediate and expensive bounce back into hospital) and start building a relationship. This service is paid for by commissioners, not UVMP, because it saves money; the reduction in admissions and time in hospital as a result of better care saves money, as well as improving health.
That final point is key. When people have better health, the health system works better — it’s under less strain, it requires less funding, and it can provide higher quality care.
You may also have been surprised by the number of hostels in Manchester. I certainly was. But there are a lot more services than I had suspected. The obvious things are there; very few people go hungry, and there are pathways to getting accommodation, benefits, and help back into a stable life. But there are factors that keep people at the bottom of the pile, which I’ve mentioned before: drink and drugs, poor mental health, and poor physical health. They all need fixing at once, and none of them are easy to do. That’s why the problems are so complex, and why none of the solutions are simple.