By Primary Care Journal-
Dr Wan-Ley Yeung, GP Clinical Lead for the SPCT Inclusion Service, analyses how primary care services can become more accessible for marginal groups
People experiencing homelessness and other marginalised groups including sex workers, Gypsy communities, travellers and show-people, migrants and refugees can have a distinct set of circumstances that act as barriers to their healthcare. These can include the tri-morbidity of physical ill health, mental ill-health and substance misuse, poor familiarity with local healthcare provisions alongside language and education barriers.
Common threads can include insecure accommodation, discrimination, socio-economic deprivation, stigma, stereotyping, a lack of trust and a lack of registration with general practitioners or dentists for their primary healthcare. When concerns that dominate your life include where you may safely sleep; where you might get your next meal from or how you might secure your next income; your personal health including oral healthcare very quickly falls to the bottom of your priorities.
The Salford way
Salford is the 18th most socially deprived local authority in England. Salford Primary Care Together (SPCT) is a Community Interest Company that exists to improve the health and wellbeing of all Salford people by putting general practice at the heart of joined-up care in Salford. As a values-driven organisation, we have four values at the heart of all of our decisions and actions; collaboration, innovation, learning and compassion. The SPCT Inclusion Service is a branch that seeks to reach out to groups that struggle to access mainstream general practice and give them the help and support they need to improve their health and reach their potentials.
In order to bridge the health divide in these populations that primary care traditionally struggles to engage with, we have built strong links and partnerships with different Salford Community and Voluntary Services (CVS) that work closely with these marginalised groups and often advocate for them through different projects around our city. They know these groups best and understand the problems faced by each them on a day to day basis and include Emmaus Salford, Salford Loaves and Fishes and the Salford Unemployment and Community Resource Centre (SUCRC). We also collaborate with statutory organisations like Salford City Council, Salford Clinical Commissioning Group, Salford Royal Hospital and Revive Dental Care to inform the system about specific needs that must be addressed to give the marginalised groups in Salford a voice at local, regional and national levels.
Together we have looked at some of the issues faced by these populations with a compassionate lens. The SPCT Inclusion Service is always seeking to innovate with new approaches and ideas such as our health pod initiative. This is an attempt to help lessen the digital divide by providing marginalised groups with a public venue where they can access remote consultations by providing mobile tablet and smartphone hardware into hostels and day centres in Salford with telecom networks paid for by SPCT so that there is no cost to the user.
We have a team that offers more outreach work taking services to marginalised groups. They recognise the importance of building trust through having cups of tea with people who may have experienced more of an unpleasant and seemingly unhelpful health care service. The team has flexible working hours, recognising that the needs of these populations may not be serviced in a nine to five working day. Examples include the street walks with the council rough sleeping team that happen in the early hours of the morning.
Boosting access, increasing outreach
The SPCT Inclusion Service has worked to network and link with local support services to have a capacity for 'critical time interventions'. This is when the vulnerable person makes the huge step forwards to ask for help, we are able to offer a variety of wraparound support services to them in a swift and timely fashion. This was vastly improved when we collocated our base to the Salford Loaves and Fishes, local vulnerable persons’ day centre. Here hot meals and showers are offered alongside a physical presence of the drugs and alcohol agency, housing support, Citizens Advice Bureau, support workers and primary care team who can offer their assistance.
We also worked with the SUCRC to offer registration for people experiencing homelessness and ex-offenders leaving prison. This was an innovation funded project which attempted to engage and improve the health of this population. We tried to use the voluntary organisation as a single point of entry to get an individual supported for housing, food, education and health. We were able to successfully deliver an influenza campaign for registered and unregistered patients in the neighbourhood where the project was based and also offer emergency dental treatment for them.
If there were clear signs of dental fear from people they were afforded the time to go to the dental practice and sit in the waiting area, before returning another day. Having flexible appointments without pressure from the clinical team and support workers that could accompany people to the dentists certainly helped over 50 services users to attend either an initial dental check-up and/or some form of dental treatment through Revive Dental Care. The project also received donations of toothpaste and toothbrushes which were distributed to ex-offenders and homeless clients by the SUCRC.
Continuing our efforts to engage with the marginalised populations of Salford we have plans to work with St John Ambulance to offer mobile clinics that can travel to ‘hot spots’ for rough sleepers in the city providing more accessible venues. We are also developing an in-reach service to support any of these vulnerable populations that attend Salford Royal Hospital to help assist decision making in their care and help buffer their transition back into the community.
Not all of our projects and ideas have been successful. However, failure should never be an inhibitor to progress and innovation. In fact, through failures, The SPCT Inclusion Service has learnt some valuable lessons to improve the service development of other areas of work. They have also taught us first-hand about areas such as information governance and how to approach problems differently, finding solutions in novel ways.
Our experiences in Salford have gifted us key some principles in engaging with marginalised populations. These include linking and collaborating with as many local partners and peer support groups as possible from both the statutory, voluntary and community organisations. Having a seat at the table where strategic and planning decisions are made to provide a voice for their health needs which might otherwise go unheard.
Having a flexible method and approach to appointments and the workforce allows the capacity to respond to different situations that would otherwise not be dealt with. Finally having a fantastic team that share the vision and passion of our service and will go above and beyond what is required of them at times makes it an exciting, compassionate and rewarding service to be part of.