North East Lincolnshire: Providing rough sleepers with GP care and more

A dedicated GP surgery for vulnerable groups, including homeless people, has been set up in Grimsby. The practice provides everything from general health care to food parcels and advice on housing and benefits.


The challenge

Over 10 years ago nurses working in Grimsby began to identify large numbers of people who were not registered with a doctor. This included asylum seekers, drug users, ex-offenders, sex workers and, of course, homeless people.

Research suggests these vulnerable groups are the least likely to access healthcare via GP surgeries.

With the help of funding from the Department of Health’s social enterprise fund, a new primary care service, Open Door, was established in the centre of the town by the Care Plus Group.

The solution

Today, Open Door is a thriving and busy multi-disciplinary health centre. It employs practice nurses, advance nurse practitioners, healthcare assistants and a sexual health outreach worker alongside GPs.

It relies on word-of-mouth and referrals in from the voluntary sector, faith groups and North East Lincolnshire Council and NHS services to identify patients. They are provided with a full range of treatments, health checks and immunisations.

But as well as providing direct health care, Open Door also places a big emphasis on helping patients in other areas of their lives too. There is a social advice worker who can help them access benefits and employment support, while a housing advice service is also run from the centre. The council also provides a dedicated financial advisor to run sessions on some days.

The centre works with a local church group and Asda to provide food parcels. Toiletries, food bank vouchers and clothes are also handed out at times.

Impact

Open Door tends to work with around 50 homeless people at any one time, although it has around 1,600 vulnerable patients registered at the practice altogether.

The national GP Patient Survey shows how valued the practice is. Some 84 per cent describe their experience getting appointments as good, well above the local and national averages.

General Manager Kirsty Newson said: “The support provided really makes a difference. Patients can come in get treatment and then see an adviser and get help with wider issues. It is about taking the opportunity to support them holistically as much as you can when they are in.

“The needs of our patients, particularly the homeless people, are incredibly complex so we have to offer a much wider range of service than you would normally get in a GP practice.”

Lessons learned

Over the years, Open Door has moved towards running more drop-in services rather than relying on traditional appointments.

Mrs Newson said: “Our client groups, particularly the homeless patients, are not really that good at attending appointments at specific times. They don’t have mobile phones or watches. We have found that we have much more success by running drop-in clinics.

“Twice a week we have a leg ulcer drop-in clinic. That is very important for homeless patients. They can just turn up and they are guaranteed to get help.

“We have also run open days where there are no other appointments. We have done ones on sexual health and where they can get reviews for COPD and mental health.”

Mrs Newson said it is also important to consider the security of both staff and patients when establishing services for homeless people.

“Sometimes when they come in they are under the influence of alcohol or drugs. They can get aggressive and so you have to take the right precautions for staff. We have installed extensive CCTV and have strict lockdown procedures. The way rooms are set up means staff are always able to exit first.”

How is the approach being sustained?

“Doing more outreach work is being targeted as a key priority”, says Ms Newson. “The sexual health outreach nurse goes on to the streets, but as yet the core nursing team does not.

“We know some patients will not always engage with us, or they may not return when we ask them to, so we are keen to do some outreach work and see if we can engage them like that.” she said.

One of the key partners in this is likely to be Harbour Place, a homeless shelter that is very close to the Open Door centre. It is in the process of installing some treatment rooms, which Open Door nurses can work from, with the view to then doing some outreach work with their staff.


Contact details

Kirsty Newson
General Manager
Open Door
kirsty.newson@nhs.net