Healthcare for ‘rough sleepers’ in Lewisham
Over the course of a year, around 8,000 people sleep rough in the capital. That number has increased significantly in the last decade.
Homelessness is very often a cause of worsening health. Many people who sleep rough will have significant needs in relation to physical health, mental health and substance misuse.
However, current systems of healthcare can struggle to meet their needs. Homeless individuals use hospital inpatient services eight times more than other people of similar age, and are more likely than other members of the general public not to be registered with a GP.
In 2017, local people in Lewisham, South East London, raised concerns about the availability of health services for rough sleepers in their community — in particular in the Deptford and New Cross areas. In response to these concerns, NHS Lewisham Clinical Commissioning Group (CCG) set out its commitment to provide bespoke GP services for homeless people; specifically for those termed as ‘rough sleepers’ in Deptford and New Cross.
We speak to Dr Surinder Singh, a GP at the Amersham Vale Practice in London, who was part of the team who established the service and continues to help run it.
How did the GP service for rough sleepers in Lewisham come about?
Following concerns raised by local people in Lewisham, our CCG organised a summit with various people and organisations — such as the council, local GPs and charities — to consider how we could best support the health needs of rough sleepers in our area.
We then engaged with the local community and potential service users to help shape and co-produce the development of this pilot service.
A major part of this work was to understand the barriers that homeless individuals face in trying to access health care.
What is offered to service users, where, and for how much time each week?
The service operates two weekly drop-in clinics offering 6 hours of GP care to rough sleepers in Lewisham aged 18 years and over. One clinic operates from a local GP practice (Amersham Vale) and the other is delivered as an outreach clinic located at a charity.
What adaptations have you made to a ‘routine’ GP service to ensure it is sensitive and appropriate to the needs of service users?
Due to the complex health care needs that service users can present with, we work closely with other service providers to ensure that patients are effectively supported, referred, signposted and receive good quality, coordinated care.
Monthly multidisciplinary team meetings are held to discuss patient cases and these have representation from the Nurse Health Intervention Team social services, drug and alcohol services, mental health services and local homeless charities. It’s really important that all partners work together to support patients — many of whom have complex physical, social and mental health needs.
How are you advertising the service so the right people hear about it?
Feedback from the public and stakeholder engagement helped us to work out how best to inform people about the service. Direct engagement with the homeless population, and working with local charities, has enabled us to develop target our advertising materials so that we reach the right people.
Posters and leaflets to promote the service were designed with service users, who informed the words, look and feel of the materials. We also developed travel card wallets which we have distributed to service users and other services that rough sleepers may use. The wallets included a copy of the Healthy London Partnership card ‘Your right to see a GP’ which aims to support the public in accessing primary care services.
Are there any emerging findings from the pilot?
The majority of patients (approx. 49%) identify themselves as rough sleepers with the remaining reporting as either sleeping in a night shelter, ‘sofa surfing’, living in a homeless hostel or living in a squat.
The service is predominantly accessed by males who have become homeless in the last 6 to 12 months. 75% of users are not registered with a GP however the service supports unregistered patients to register with a GP practice. Patients are registered as a temporary patient with the provider GP practice (Amersham Vale). Registration enables access to all general practice services. This has resulted in improved access for these patients to primary care and a number of these patients have been seen at the practice outside of the drop-in clinics, which is really good news.
There are several specialist GP practices that support homeless people in London, as well as some mainstream practices which also offer services.
People do not need a fixed address or identification to register or access treatment at GP practices.
- Search for health services for homeless people here
- Healthy London Partnership has resources to help healthcare professionals support homeless people in accessing services.
The NHS Long Term Plan commits up to £30 million extra to support the needs of rough sleepers, to ensure that the parts of England most affected by rough sleeping will have better access to specialist homelessness NHS mental health support, integrated with existing outreach services. Find out more at www.longtermplan.nhs.uk
