Archived: Brighton Homeless Healthcare

Updated 27 August 2015

Brighton Homeless Healthcare offers specialist GP services to homeless patients in Brighton and Hove. There are approximately 1300 registered patients.

The practice is run by The Practice Group. The practice was supported by central management functions from the head office, including human resources, health and safety and clinical locality leads. The practice was also supported by two GPs, including one who was regional clinical lead for The Practice Group, two nurses, and a team of receptionists. Operational management was provided by the practice manager and the assistant practice manager.

The practice runs a number of services for its patients including asthma clinics, child immunisation clinics, diabetes clinics, new patient checks, wound care, a substance misuse service and weight management support.

Services are provided from:

Brighton Homeless Healthcare

Morley Street

Brighton

BN2 9DH

The practice has opted out of providing Out of Hours services to their patients. There are arrangements for patients to access care from an Out of Hours provider.

The practice population has a higher percentage of patients with a long standing health condition (90%) and those with health related problems in daily life (89%) compared with the England and CCG average. The practice population also has a higher number of patients claiming disability allowance compared with the England and CCG average, plus a significantly higher percentage of unemployment and a lower percentage of patients in paid work or education.

Updated 27 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Brighton Homeless Healthcare on 12th May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for the care of all the population groups and we saw an element of outstanding practice in relation to care of people in vulnerable circumstances who may have poor access to primary care.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to legionella re-inspection and undertaking regular fire drills.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

We saw one area of outstanding practice:

• The practice held multidisciplinary team meetings weekly at the local hospital and fortnightly with local homeless hostels to discuss patients with complex needs. For example, those with multiple long term conditions, mental health problems, those with end of life care needs or children on the at risk register).

However there were areas of practice where the provider needs to make improvements.

The provider should;

• Should ensure risk assessments and action plans are followed such as the frequency of legionella inspection.
• Ensure regular fire drills are undertaken.
• Ensure access to the practice is within the contractual opening times of 8am to 6.30pm.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 August 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 27 August 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of Accident and Emergency attendances. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives, health visitors and school nurses.

Updated 27 August 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 27 August 2015

The practice is rated as good for the care of working-age people. The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, when patients had secured regular employment and were no longer homeless, the practice would support them to transfer to another practice in their community while providing an on-going service to ensure continuity of care. The practice was proactive a full range of health promotion and screening that reflects the needs for this age group.

Updated 27 August 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). 100% of people experiencing poor mental health had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia and those requiring substance misuse services. It carried out advance care planning for patients with dementia.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. It had a system in place to follow up patients who had attended Accident and Emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 27 August 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. All patients within the practice were living in vulnerable circumstances and were either street homeless, in temporary housing or part of the travelling community. It offered longer appointments for all patients and provided both appointment and walk in services to meet the needs of the population group.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and worked collaboratively to provide outreach in the community in ways that would make it easier for vulnerable patients to access the service. It had told vulnerable patients about how to access various support groups and voluntary organisations and frequently worked together with these organisations to meet patient needs. It worked proactively to identify reasons for difficulties vulnerable patients had in accessing services and took action to address this, for example running dedicated clinics for women and providing outreach services. Staff knew how to recognise signs of abuse in vulnerable adults and children and they had systems in place to address concerns. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.