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RCGP commissioning guidance says action needed to help vulnerable groups

6th January 2014

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

The paper, Improving access to health care for Gypsies and Travellers, homeless people and sex workers, written by the Royal College of General Practitioners and 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.
Cultural awareness training for frontline NHS staff dealing with Gypsies and Travellers is another key recommendation in new guidance, aimed at improving access to healthcare for vulnerable groups.

The report also calls for:

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.

Sex workers

According to the report, sex workers are gradually moving off the streets making them harder to contact.
General practitioners who commission health services in England 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 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.

Homeless people

On the issue of providing health services for homeless people, the paper says that the impact of rough sleeping on the wider health and life expectancy of individuals is well recognised. A recent evaluation by Crisis assessed the average life expectancy as being 47, as opposed to 77 for the general population.

The report says that to help tackle the health needs of homeless people, GP 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.’

Gypsies and Travellers

On the issue of providing health services for Gypsies and Travellers, the report says that 42% of English Gypsies are affected by a long-term condition, as opposed to 18% of the general population.

The paper adds that there a range of contributing factors to the poor health outcomes of Gypsies and Travellers, and the difficulties in accessing services. These 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.”

A Department of Health spokesperson said:
“With the implementation of the 2012 Health and Social Care Act, we have a unique opportunity to try to get things right and break the circle of exclusion for some of the most vulnerable in society.

“In this changing landscape, with GPs becoming commissioners as well as providers of care, we need to make sure that some of the most vulnerable in society remain high on the agenda.”

Download the guidance Improving access to health care for Gypsies and Travellers, homeless people and sex workers [PDF]
The guidance was funded by the Department of Health’s Inclusion Health programme in collaboration with the University of Birmingham and Hull York Medical School


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