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How we serve a gypsy community

Dealing with the unique health problems of a travelling community is not easy – but, as Dr AS Vijay Kumar discovered, it is not impossible.

Dealing with the unique health problems of a travelling community is not easy – but, as Dr AS Vijay Kumar discovered, it is not impossible.

Askern Medical Practice in Doncaster had been run by its PCT for just under two years without a GP lead. When we took over, we were asked to provide continuity of care for the patients in this highly deprived area.

Askern hosts one of the largest traveller communities in the UK, and within the practice boundaries there are about five camps. Initially, the traveller community had very low expectations of the practice because they were used to seeing locums. Once the new team took over, the travellers had a named GP they could engage with.

Although we do not have an exact number for the traveller population, we believe there are close to 600 patients living ‘permanently' in houses and hard-standing caravans – and many times that number who pass through the area temporarily.

How did you engage with the travellers?

With the advent of the QOF and the new contract, we found that patients living in certain postcodes and in certain camps had much worse health outcomes than the rest of the local population. We found that the rates of cancer, asthma, coronary artery disease and smoking were higher in the traveller groups. We also needed to improve the rate of childhood immunisation among gypsies. We decided that engaging with the gypsy population directly would help with all of these health issues.

What health services were set up?

The following services were set up for the gypsy community:

• cardiovascular assessment

• childhood immunisation

• a local extended minor surgery service

• diabetes screening.

What were the main problems?

The first hurdle was suspicion towards the practice, especially among the older generations. This had been compounded by two years of the PCT running the practice with locums. To overcome this, we sat down with the gypsy elders and asked them what services they wanted.

Another problem was the population's transitory nature, which made keeping appointments difficult. Some patients would move to the North-West or Scotland for work, and in some parts of the year they even worked in Canada and northern Europe. We now use Choose and Book to offer appointments at a time and place that suits their movements. For instance, a patient in Yorkshire could access a hospital 100 miles away in an area where they would be living at the time of their appointment. The consultants were made aware of this so that letters about follow-up appointments could be sent to the right address.

The chaotic lifestyles that the travellers lead also had to be integrated into the provision of services. For instance, many of them work late into the evenings and can only visit GPs after 6pm. We also made sure that the minor surgery service had short waiting times to allow for the transitory nature of the patients it serves.

One of the main problems with childhood immunisation is that families of immunised children were often ostracised by their community because of a strong belief that vaccines would poison the children. To ensure the take-up of childhood immunisations, visits were made to gypsy camps and notices were placed in many areas. Initially, the take-up was poor. But once the gypsy elders were on board and their grandchildren were immunised, more came forward. Since then, the rate of immunisation has risen from 56% to just under 90% in three years.

Dr AS Vijay Kumar is executive partner at the Askern Medical Practice, South Yorkshire

Dr Vijay Kumar has set up a minor surgery service for the gypsy community

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