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NHS must do more for vulnerable people

GPs suggest one stop ‘healthcare hubs’ for travellers, sex workers and the homeless

Mark Gould

Monday, 16 December 2013

Radical changes are needed to meet the healthcare needs of vulnerable such as sex workers, Gypsies and Travellers and homeless people, according to new commissioning guidance for GPs.

"Improving access to health care for Gypsies and Travellers, homeless people and sex workers", written by the Royal College of General Practitioners (RCGP) and the Department of Health says that GPs who commission services in England, under the Health and Social Care Act 2012, should consider paying for mobile units and clinics, and other outreach facilities. 

It also calls for cultural awareness training for frontline NHS staff dealing with Gypsies and Travellers and recommends:

  • More "one-stop" healthcare hubs where vulnerable groups can receive multiple services in one place at one time.
  • Greater community engagement to allow vulnerable groups to have their voice heard and develop support networks.
  • More localised decision making for commissioners, who should seek greater collaboration with vulnerable groups to deliver mutual health and financial benefits.
  • More communication and joined up working between health, social care and voluntary services targeted at marginalised groups.
  • Greater integration between health and housing services to identify and treat health problems associated with poor living conditions.

The report says that as sex workers are gradually moving off the streets it makes them harder to contact. To tackle the problem, commissioning GPs should consider paying for mobile units, dedicated clinics and one-stop shops in urban areas, to allow the thousands of people who work in the sex industry to have better access to health services.

Bringing services directly to sex workers, will often be an effective strategy to ensure they undertake the first step to address their health needs, for example on-site testing, says the report.

A recent evaluation by homeless charity Crisis assessed the average life expectancy of homeless people as being 47, as opposed to 77 for the general population. The report says commissioners should put an emphasis on outreach services, stating that outreach “is a very important element, as it not only provides an opportunity for initial engagement on the streets, but also supports new rough sleepers before they become entrenched in the lifestyle”.

The report says that 42% of English Gypsies are affected by a long-term condition, as opposed to 18% of the general population. Factors contributing to poor health outcomes of Gypsies and Travellers, include low levels of literacy, together with stigma, poor access to health information and some widespread health-beliefs which increase the likeliness that they will not seek treatment.

RCGP Chair Dr Maureen Baker, said: “Under the Health and Social Care Act 2012, commissioners of healthcare in England now have a duty to reduce health inequalities in access to services and outcomes. It is vital that commissioners put the needs of forgotten and disenfranchised groups at the heart of their commissioning strategies.”

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