Manchester Extended Access Service (MEAS)
The extended access service was repurposed in April 2020 to support the response to the coronavirus pandemic. This response is being coordinated and provided by Northern Health GPPO, Primary Care Manchester and South Manchester GP Federation.
Homeless Access Service (HAS)
BackgroundLosing a home can be the consequence of different structural or personal factors. In the past ten years, the number of households affected by homelessness has increased across the country.
During this time, welfare reform has introduced the freezing of Local Housing Allowance, benefit caps for low-income families, and Universal Credit; average rents in the private-rented sector have increased, and demand for social affordable housing has grown, outstripping supply.
In 2017, more than 300,000 people in Britain – the equivalent of one in every 200 – were officially recorded as homeless or living in inadequate homes. In addition to this, in 2017 the number of people sleeping rough in England rose for the eighth consecutive year. There were 4,751 people counted or estimated by local authorities to be sleeping rough in England on any one night in autumn – a 15% increase from the 2016 figure of 4,134, and more than double the 2010 figure. Manchester reflects the national trend in the number of households that have lost their home. Both the use of temporary accommodation and the number of people who experience sleeping rough have increased.
At the same time, the number of affordable houses on the Local Housing Allowance rate has shrunk, and pressures on affordable social housing is increasing. Housing options for people on low incomes or those receiving housing benefits are becoming limited. Financial vulnerability and levels of poverty have increased. Experience of childhood poverty is closely linked to experience of adult homelessness; Manchester has one of the highest child-poverty rates in the country.
Manchester’s Homelessness Strategy 2018-2023 has a clear aim, to end homelessness in the city. It is also realistic about the challenge this sets, and that pragmatically steps are required to support people in the city now.
Homelessness is a sad reality in the city of Manchester and the provision of the Homelessness Access Hub will play a role in supporting those throughout Manchester access high quality and relevant primary medical care services, which also act in a joined up way with other services.
MobilisationDuring the latter part of 2019, Manchester Primary Care Partnership worked with Manchester GPs to get the newly commissioned HAS project off the ground, and improve access to healthcare for some of the most vulnerable people in the community. The service will be delivered from seven practices as detailed below.
The approach looks to support practices for the time they spend ensuring people who are homeless receive improved access to healthcare; in some cases practices are already carrying out some or all of this activity, and there is no intention to remove patient choice. Therefore patients who are registered at other local practices will not be compelled to alter their registration.
Each participating practice will receive funding to support them to provide sustainably improved access. There has been a staggered approach to mobilisation, depending on when the service in a particular practice went live with seeing patients, the scheme will run for 12 months from that point and be reviewed to refine and improve the offer to patients and practices over time.
HAS will support the people of Manchester who meet the following definition:
“A person is considered homeless if they have no home in the United Kingdom or anywhere else in the world available to occupy. Homelessness can include:
The approachEach HAS practice will provide something different based on what they believe the local community will want from the service, but all the hubs will:
- Participate in training in homeless and inclusion health for all clinical and non-clinical (receptionist) team members.
- Register people from hostels, hotels, and other homeless people from within the neighbourhood – and use the practice address where needed.
- Will review provision of responsive access to appointments for those who are homeless, and develop an appropriate level for the population.
- Provide a new patient health check including BBV/STI and health plan to every new registration of a homeless person.
- Link into Be Well and other neighbourhood support organisations.
- Won’t penalise DNA if coded homeless.
- Treat Homeless patients with long term conditions are treated to QoF standard wherever possible.
- Attend Quarterly best practice group to build shared learning and peer review.
- Participate in developing an approach for:
- supporting patient transfer between Access hubs if a patient moves;
- Wound treatment.
- Annual follow up/review with reporting to support recall.
More details on the specialised offerings are below.
Ashcroft Surgery (Gorton & Levenshulme neighbourhood)
Will provide dedicated clinic appointments for people who are homeless held on a Wednesday AM, wrapped around the current Drug clinic, supported by wider MDT members to provide holistic health and social care support. Be Well and Focused Care workers will also support on a Wednesday AM and the practice is exploring if a housing officer can also attend.
Beacon Medical Centre (Higher Blackley, Harpurhey & Charlestown neighbourhood)
Will be flexible to the needs of a homeless person and should the person walk in to the practice they will ensure that they are seen by a health professional and also supported if needed to complete any forms. The practice will also embargo slots with the Nurse Prescriber (or GP in her absence) for Homeless patients who may turn up. The appointment would be booked by the reception team and a message sent to the clinician. The clinician will have the flexibility to see the patient as soon as possible. This will be monitored and the number of appointments adjusted depending on need/usage.
Cheetham Hill Medical Centre (Cheetham and Crumpsall neighbourhood)
Will provide10 ring fenced appointments per week for homelessness patients. Add alerts on to homeless patients records and if contacting the practice, prioritising them to have a same session appointments. The practice will utilise a HCA trained to support mental health issues as relevant.
City Health Centre (Miles Platting, Newton Heath & Moston neighbourhood)
Provide dedicated Homelessness Advanced Nurse Practitioner clinics every two weeks, these clinics will include GP oversight and escalation where required. The practice will also utilise dedicated mental health worker resources to follow up on clinically appropriate patients and ensure the physical health support they receive from the ANP clinics is complimented by holistically supporting their mental health needs. City Health will also run discrete homelessness focused seasonal campaigns, for example in relation to Flu to ensure coverage for this group.
Cornbrook Medical Practice (Hulme, Moss Side & Rusholme neighbourhood)
Run a Pop-up clinic to support the local morning star hostel. Home visits will be provided to local hostels on a Thursday PM to support proactive and reactive care and strong working relationships with local hostels. Patients who are homeless may also benefit from the practices approach to general triage at city road, which will be explained to new registrations at open access on a Monday PM. The practice will also utilise a HCA trained to support mental health issues as relevant.
Dr Cunningham & Partners (Ardwick & Longsight neighbourhood)
Provide 8 ring fenced appointments per week for homelessness patients. The practice will use the Drug & Alcohol clinic to drive opportunistic screening and checks towards QoF with no blanket exemptions.
Lime Square Medical Practice (Ancoats, Clayton & Bradford neighbourhood)
Will be flexible to the needs of a homeless person and should the person walk in to the practice they will ensure that they are seen by a health professional and also supported if needed to complete any forms. The practice also holds a regular Be Well clinic.