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Health E1 is an established nurse-led PCT PMS practice which was set up in 2000 to address the primary, mental healthcare and substance misuse needs of street homeless and hostel dwellers in the London Borough of Tower Hamlets.
This is an often excluded group because generally patients without an address are not able to register with a GP in the usual way. This area has a large number of hostels and day centres and, in the past, there has often been an inappropriate use of local A&E and Walk-In Services as homeless patients tended to use these instead of seeing a GP. At Health E1 we interpret the definition of homeless quite broadly, thereby encompassing street-homeless, those living in local hostel accommodation, bed and breakfast or temporary housing along with squatters, refugees and asylum seekers. We offer full, permanent registration with the practice thereby providing continuity of care.
The broad aims of the practice are to provide a comprehensive package of healthcare for homeless people, along with improving access and to encourage their integration into mainstream service provision. The Practice has worked very hard to not only provide the highest standard of general care but also to try to tailor services to the particular needs of this challenging client group.
Unlike most practices, we run a combination of open access (walk-in) clinics along with booked appointments. We have found that this better suits the needs of most of our patients who very often find it difficult to keep to rigid timetabling and appointments. Alongside this the substance misuse clinical nurse specialists keywork a very successful drug treatment programme using methadone and buprenorphine. Substance misuse is a huge problem amongst homeless people and approximately 50 % of our patients have current or previous problems with drugs or alcohol.
Another big problem amongst the homeless population is that of mental health (either diagnosed or undiagnosed) and dual diagnosis (a patient with a diagnosed psychiatric condition who also misuses alcohol or other substances). It is often very difficult to access mainstream psychiatric services for patients of no fixed abode. Assessment and follow up are set to fail because of the very nature of our clients chaotic lifestyles. Our mental health clinical nurse specialist has a wealth of experience in this field and, because he is based at the practice, can very often engage clients quickly before they are lost within the system.
The other area that we see a great need is in our large refugee and asylum seeker population. This group has a high prevalence of depression, post traumatic stress disorder and somatic complaints. We have gone some way to addressing these needs through the work of our clinical psychologist and mental health nurse.
Alongside our regular staff we have sessions provided by the blood borne virus nursing team three times per week – they provide blood testing for HIV, hepatitis etc along with counselling and related services. The Tower Hamlets Community Alcohol Team runs weekly sessions for our patients wishing to tackle their alcohol problems. We are also very fortunate to have recently secured sessions provided by Consultant Psychiatrists from the CMHT service and the Dual Diagnosis Psychiatrist from Specialist Addiction Unit. Providing their services at the practice rather than patients having to attend the hospital has significantly lowered the instances of DNA’s and has increased patient engagement.