How a Manchester practice has led pioneering work over the last 20 years to help more homeless people have access to a GP
Dr Gerry O’Shea from Urban Village medical practice in central Manchester is no stranger to working with the homeless.
The Manchester-born GP was one of the doctors behind the city’s first purpose built-doctors’ surgery for the homeless, in the then offices of the Big Issue in the North, during the late 90s.
Since then Dr O’Shea, 53, has continued his work to address health inequalities – in particular breaking the ‘catch 22’ cycle where homeless people were denied registration with a doctor because they had no fixed address.
Today, he and his colleague Dr Shaun Jackson and six other doctors operate from a busy practice in Ancoats, where around 750 of the 10,500 patients are homeless – and have all been able to access permanent registration using the practice address or a temporary address such as a friend’s place or a day centre.
The bustling practice has all the usual services offered by an inner-city surgery – and it also offers flexible access arrangements to homeless patients throughout the week, including a weekly drop-in clinic for the on Wednesdays between 2:30 and 4:30pm.
“The ethos at our practice is one of inclusion,” says Dr O’Shea.
“Homelessness is a very broad category – from temporary homelessness to rough sleeping. We want all our patients to be integrated into the care of the practice, regardless of their circumstances. The fact that a patient is homeless is almost an incidental factor.
“However, we do recognise that some homeless people will have multiple and complex health issues which need extra time to deal with – this is why we offer flexible access.”
The service is staffed by service manager, three case managers (based at the practice, but also work within hospitals) and two specialist nurses who work from within the surgery and also do outreach work in hostels and day centres. Between then, the whole team work to address any other underlying issues such as addictions and social problems. They also help patients with housing-related paperwork and direct them to other care and service providers.
“It’s vital that homeless people know that they can and should register with a doctor,” Dr O’Shea continues. “If a health problem is detected early it can be dealt with before it develops into something much more serious.
“Just like with any other patient, it’s all about gaining confidence and trust – the more we do this the more likely we are to be effective.”
This experience put Dr O’Shea, Dr Jackson and other Urban Village team members in an ideal position to be part of on an initially pilot project, working with Manchester Royal Infirmary staff. The “Mpath” service – which stands for Manchester Pathway – (a small team consisting of GPs, nurses, case managers and housing workers) started in June 2013.
The project was designed to improve the outcomes for homeless people admitted to hospital by, for example, ensuring GP registration and follow up on discharge. This would also reduce A&E attendances.
It is based on the work done in the capital city by the charity Pathway, which has developed innovative ways of working in the NHS to make health services better for homeless people.
“The fundamental aim of the project is to prevent a ‘revolving door’ system whereby a homeless patient goes to A&E for multiple visits for a health problem because they have no access to a GP. And for those patients who are admitted, we want to be able to reduce their risk of becoming ill again by giving better access to primary care and linking with housing services,” says Dr O’Shea.
“For example, leg ulcers can be common with rough-sleepers and lead to A& E visits. If the person had access to a GP in the first place the chances are that the ulcer could have been treated at primary care level.
“Once an ulcer becomes a serious issue it can lead to complications like septicaemia, which would involve more hospital visits and the likelihood of more health problems.
“Dealing with health concerns at a primary level has many social, health and economic advantages.”
National research shows that homeless patients attend A&E around five times more that the general population and are almost four-times more likely to be admitted.
“So far the MPath healthcare team has engaged with over 458 homeless patients in the last 12 months, who have been admitted to Manchester Royal infirmary, or attended A&E,” says Dr Jackson.
“We have also worked with Manchester City Council, Manchester's Health and Wellbeing Board and other agencies to help patients into accommodation or day services and are also part of the Big Change campaign which enables the team to purchase clothes and toiletries for patients who go into hospital with nothing.
“This integrated approach to healthcare has had some extremely positive results in both the health and living situations for our patients.
“We have also been able to demonstrate considerable cost savings for the NHS. The patients we work with attend A&E less frequently, spend less time in hospital beds and once they are discharged from hospital are significantly less likely to go back. It is an example of how a relatively small amount of money invested in a new approach to healthcare - for an often ignored population - can result in significant money savings for the NHS and public services in general.”
“We are now very much embedded within the hospital and the communication and knowledge shared through our teams around complex needs has really developed. That for me, is at the very heart of how we can all work together for better results for those who are homeless.”