The Scottish Deep End Group, that represents GPs working in 100 socio-economically deprived areas in Scotland, shares concerns about the closure of a specialist GP practice for homeless people in Glasgow
The Hunter Street homeless practice in Glasgow was recently closed by Glasgow City Health and Social Care Partnership, and we GPs at the Scottish Deep End Group are deeply concerned about both the rationale for closing the service and the way in which it has been managed.
We are aware that this has been done without assessing what risk this brings for individual patients or for the professional teams in health and social care who rely on this practice as a safety net for some of the most marginalised people in society. There was no health needs or equality impact assessment or consultation about the impact of this action. The many clinical teams in the city who support people experiencing homelessness, including our emergency department colleagues, are very worried.
Furthermore, this is happening during a cost-of-living crisis and at a time when mainstream general practice is already in a precarious state and unlikely to be able to adequately meet the often-complex needs of this patient population. The importance of a dedicated specialist service is perhaps greater now than ever before. We know of many patients who have been adversely affected by this already, including not being able to get vital medication, or fit notes so they can access benefits.
The need for specialist services
Patients experiencing homelessness generally have very complex health and social care needs, which require time, expertise and high-level cross-sectoral working to support them. This is far more achievable in a specialist homeless health service setting, and most major cities and towns in the UK provide such services. For instance, Edinburgh has such a practice, and there is also some level of provision (proportionate to need) in Aberdeen and Ayrshire.
Glasgow has by far the most people experiencing homelessness in Scotland, with a significant number of new presentations every week. This figure is likely to rise further in the current economic climate.
The recently published professional guidance by the National Institute of Clinical Excellence (NICE) specifically recommends that ‘more effort and targeted approaches are often needed to ensure that health and social care for people experiencing homelessness is available, accessible, and provided to the same standards and quality as for the general population’.
NICE advises that the design and planning of services should be based on a local homelessness health and social care needs assessment and that this should ‘assess the quality and capacity of existing mainstream and specialist service provision to inform the need for service development and investment’ and ‘assess access to and engagement with current services by people experiencing homelessness’.
The impact on mainstream general practice and access to care
The key impact of closing the Hunter Street homeless practice is that Glasgow will lose the safety net of having a generalist medical service (with specialist expertise in inclusion health) for patients who have no other way to access general practice care.
While many people experiencing homelessness will be able to remain registered with their own GP, not all of this population can (or may struggle to register with a practice). For them, they now have no way of accessing routine care such as medication, arranging sick lines (required to avoid benefit sanctions), or GP review for acute or chronic medical problems.
In addition, patients who were registered with Hunter Street homeless practice, who have multiple complex needs, have suddenly been transferred to a new practice with no warning in a context where GP practices are already overwhelmed.
The Scottish Deep End Group is calling for the Hunter Street homeless practice to be reinstated and developed further, so that high quality specialist clinical care can continue to be provided to people experiencing homelessness in Glasgow during these very difficult times.
Read more about the Scottish Deep End Group here