Islington Homeless Health Inclusion

Across the country, people experiencing homelessness (PEH) suffer from some of the most severe health inequalities and face significant barriers in accessing health and care services when compared with the general population. Indeed, PEH die 30 years earlier than the average UK adult, and nearly one-third of deaths are from preventable and treatable conditions.

PEH face specific challenges in accessing mainstream primary care services due to inflexible service times, unstable or transient accommodation, lack of continuity of care, fragmented services and a lack of awareness by healthcare practitioners as to the complexity of PEH needs. This results in PEH disproportionately relying on acute health services, impacting the NHS by an estimated £85m annually.

To respond to this in Islington, NCL ICB Inequalities Funding is being used to deliver an inclusive Homeless Health Inclusion programme known as the Islington Hostel Outreach GP service. The service has three primary aims:

• To identify and treat the physical needs of people experiencing homelessness (PEH)
• To understand the physical health needs of PEH in Islington
• To support a culture change with regards to mainstream primary care interactions with PEH

The Islington Hostel Outreach GP Service is staffed by 4 GPs and 1 Outreach Nurse who provide a mix of Hub based clinics and 'roaming' cluster clinics (Hostels visits). Each of the GPs work closely with a specific cluster of hostels in geographical proximity. The Outreach Nurse works closely with each cluster of hostels and has strong links at the service Hubs on Seven Sisters Road (Solidarity Hub), Stacey Street Hostel Hub and runs a weekly women only drop-in clinic. The service clinical lead provides a monthly GP and nurse drop-in clinic at Solidarity Hub with a range of pre-bookable and drop-in access slots.

In this way, the service provides high quality medical care for residents in local Islington Hostels and persons currently homeless or at imminent risk of homelessness who are based in Islington. The service team seek to enable improved access to primary and secondary care services for service users and strengthen ties with service users and their registered GP practices. Service users who do not currently have a registered GP are supported to register with a local practice.

This model allows the clinical team to offer a wide range of health offers including long-term chronic condition reviews, wound care, cervical screenings, and onward referrals to community/ secondary care services.

After an initial service scoping engagement exercise with PEH group who regularly attend a local day centre, the Islington Hostel Outreach Service was piloted in 2022/2023 and has now received renewed Inequalities Funding from NCL ICB to continue in 2023/2024. Over the course of the pilot, the team conducted 114 consultations and supported 20 patients to register with an Islington GP surgery. During these consultations, 65 onward referrals were made to secondary care (including two ‘2 week wait’ suspected cancer referrals), community services and other local services. Estimates suggest that 3 emergency department attendances and 4 GP call outs have been prevented by the services. Furthermore, 68% of all contacts in the pilot were the result of opportunistic engagement, underlining the importance of taking the care to the patient with people experiencing homelessness.