Integration of a GP into the rough sleeping outreach team in Newcastle.

Integration of a GP into the rough sleeping outreach team in Newcastle has led to improved health outcomes for many clients. The shockingly low expectancy and problems accessing primary care for people experiencing homelessness (PEH) are well documented and previously in Newcastle the rough sleeping outreach team had no specific primary care input. This led to the predictable problems of struggling to get timely access to primary care for PEH and thus a concern that the opportunity to treat both acute and long term health conditions were being missed. Following funding secured by Newcastle City Council through the Rough Sleeping Initiative a GP has provided weekly sessions to outreach to those who are sleeping rough.

The benefits to this initiative have been significant and far reaching. Those sleeping rough can be offered GP registration, BBV screening as well as a holistic health review. Individuals are routinely screened for a learning disability as we know this is a common and under recognised condition in many PEH, and standard NHS cancer screening is also arranged for those who are eligible. Individuals are discussed at a weekly MDT along with housing and drug and alcohol services and the health input that is shared (with consent) has been important in provoking a more co-ordinated and patient centred approach from statutory services. The below anonymised case study highlights the role that GPs can play in people who are rough sleeping.

Mark (name changed) had been rough sleeping in Newcastle for a number of months. Originally from Europe he had came to the UK for work but had fallen victim to modern day slavery and fled to avoid the perpetrators. He had found the asylum process difficult to navigate and had failed to submit the appropriate documentation and he was under the no recourse to public funds condition. The street outreach team and the GP met him sleeping rough and he was offered lunch and a hot drink whilst he was assessed with an interpreter via the phone. He described a traumatic childhood with little formal education, and he could not read or write in his own language. He also described a significant head injury in his early teens. This raised concerns regarding either a pre-existing learning disability or a traumatic brain injury that was impacting on his decision making and ability to navigate the asylum and legal systems.

Through the support of Newcastle City Council Social Work Department, the local Learning disability (LD) service and a third sector organisation, Mark was offered high quality temporary accommodation whilst a LD assessment was arranged with a clinical psychologist from the LD service. On the initial review it was clear that Mark had either a mild or moderate learning disability and further assessments are planned to categorise this fully and he remains settled in his accommodation. The GP continues to support his mental health and he is being assisted to complete his asylum application and work with the police around his previous experience of being a victim to modern day slavery.

The next steps in developing our collaborative response to individuals who are rough sleeping is continuing to build an evidence base locally that GP involvement in this cohort is a beneficial and a cost effective approach. The ambition is that every rough sleeper is offered a comprehensive health review when first identified as sleeping rough in the hope that it can help assist not only the individual to address unmet health needs but also the City Council in finding suitable and high quality accommodation for that individual as appropriate.

Extra information

We have permission from the individual and the organisation to share this information and we are happy to share the logos for the organisations involved.

The Learning Disability Screening Tool referenced in the text can be found here https://learningdisabilitymatters.co.uk/adult-learning-disability-form/