News Roundup [abridged Versions Appear In The Paper Journal]

Charity for homeless launches GP service for hostel residents

BMJ 2005; 331 doi: (Published 24 November 2005) Cite this as: BMJ 2005;331:1226
  1. Mark Gould
  1. London

    A partnership between the NHS and a charity that seeks to provide homeless people with a “normal” NHS GP service was launched this week. Homeless charities complain that without a permanent address homeless people can't register with a GP. Now some 93 residents of a central London hostel run by the charity St Mungo's have their own in-house GP and practice nurse.

    Camden Primary Care Trust already sends GPs and nurses to homeless drop-in centres and shelters in central London. Now Kristinn Tan, a doctor (pictured above with hostel resident Hassan Ruef-Ali) and Camille Warren, a nurse, hold twice weekly surgeries in the hostel that was once a school. St Mungo's provides the rooms for free.

    The launch comes as St Mungo's publishes the largest ever survey of the health problems of the homeless. It questioned 1491 homeless people and found that two thirds had physical health problems and more than a third who needed treatment were not receiving it. The researchers concluded that homeless people aged 45 to 64 had a death rate 25 times that of the general population.

    “Life is full of hazards,” said Dr Tan, “not just from contaminated heroin but from simply trying to find decent food to eat. We are seeing a lot more diabetes—if you live on the streets how do you control it with a decent diet, and if it's type 1 how do you keep your insulin?”

    She is amazed by the sheer toughness of her patients. “It still stuns me how people can walk through the door with acute liver failure yet they keep on going. Or people with cancer—metastasising cancer—who are living rough. In a lot of cases they don't even want to go into hospital and just say ‘give me something to tide me over.’”

    New patients get the usual health check-up, including blood pressure measurement, body mass index assessment, and opportunistic vaccinations and immunisations. Questions about lifestyle have a slight variation on the normal, taking in such queries as “Have you been in prison?” and “Have you been a sex worker?” An alcohol consumption chart on the wall records the intake of cans of “9% proof super strength beer consumed per week.”

    Dr Tan says that patients have very low self esteem; they feel they don't deserve medical care. They present with a variety of drug or alcohol addictions, mental health problems, and physical problems related to living on the street—with vascular and bowel problems very common.

    St Mungo's director of health, Peter Cockersell, says that the predicted bitter winter adds to the urgency for the NHS to devise a London-wide strategy to meet the health needs of homeless people. He says, “Homeless people need some form of sickbay—a halfway house after discharge from hospital to ensure they do not go back into the streets where their health problems started.”

    Dr Tan does not see herself as a political crusader, but says that she is worried by the fragmented nature of the service where people spend their days walking miles from benefits offices to soup kitchens to places to sleep, which only adds to their distress. Camden Primary Care Trust employs its homelessness doctors as long term locums. Dr Tan says that having a portfolio career, working two days a week in conventional general practice, protects against burnout, as does understanding the limits of what can be done.

    “Our work is a very slow process—it's about returning self esteem, getting people used to living in hostels as the first step on the road back to normal. One of the great things is bumping into someone in the street who says, ‘Hey doc; how are you?’, and you don't recognise them as the homeless person you saw before.”

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