2002 RCGP Statement on Homelessness and Primary Care
Visions and Values
The RCGP recognises that:
-
A home is more than a physical structure. It is a sense of
belonging and of personal affirmation. The best way to improve the
health of homeless people is to provide appropriate and secure
housing.
Homelessness extends beyond the familiar images of people
sleeping on the streets to encompass hostel-dwellers, travellers,
families in B&B accommodation, people in squats and those in
temporary or overcrowded accommodation such as asylum seekers and
many refugees
-
All people have a right to equity of access to primary care
services and to receive services which will enhance their dignity
and independence
Individual professional advocacy is important in
homelessness at all levels, from the consultation where the quality
of the practitioner-patient relationship is paramount, to local,
regional and national arenas
- New service models must be developed which utilise the
complementary strengths of generalist and specialist expertise.
Interdisciplinary working and multi-agency partnerships including
social service are vital to the development of effective services
in order to avoid costly duplication of effort and dangerous gaps
in care. The focus should be on inclusive practice, needs not
diagnostic labels and solutions not problems
- New ways of thinking and working are challenging and should be
underpinned by explicit support and valuing of the workforce
charged with implementing change
Back
At an individual PRACTICE LEVEL the
RCGP recommends that:
- Primary care practitioners should provide a
welcoming and sensitive service to homeless people and enable them
to access the full range of health and social services required to
meet their needs
- Homeless people should be registered
permanently wherever possible and integrated into all health
prevention and promotion activity within the practice
- Housing agencies could be encouraged to hold
advice sessions in a primary care practice setting
At an individual PRIMARY CARE
TRUST level the RCGP recommends that:
- In view of the impact of homelessness on
health, homelessness issues should be recognised as part of the
core PCT agenda
- PCTs should acquire a good understanding of the
numbers of homeless people in their area and the problems they
face, as well as the range of local agencies equipped to meet their
needs. This information will be vital in both the planning and
delivery of services for homeless people
- PCTs should provide resources for ongoing and
substantive support for homelessness services and develop diverse,
well-resourced and locally appropriate services
- PCTs should encourage multi-agency links that
are both viable and adequately sign posted to encourage integrated
services
- Agencies should work together to develop shared
protocols and operating procedures that aid integrated working and
co-ordinated care for homeless people
- PCTs should develop IT support and computer
codes that will enable the recording of degrees of homelessness and
the status and security of housing provision
- PCTs should work with local authorities to
provide social, educational and employment opportunities for
homeless people. Information about these opportunities should be
made available to primary health care teams
- Specialist opinions from appropriately
experienced psychiatrists should be readily available to
practitioners working with homeless people
- Funding should be provided in recognition of the
work involved in preparing medical reports for housing
agencies
At NATIONAL level, the RCGP
recommends that:
- Political support be offered to those working in
the field of homelessness
- Resource allocation methods should reflect the
real costs of providing primary care for homeless people
- The new GP contract negotiations should address
structural barriers that may affect the permanent registration of
homeless people including the removal of perverse incentives such
as deprivation and target payment anomalies
- Planning for electronic transfer of patient
records should address the needs of mobile populations within the
appropriate constraints of consent and confidentiality
- A collaboration should be developed with the
National Treatment Agency to explore ways of improving services for
homeless people with drug dependency
- A national web-site for homelessness should be
set up to act as a living interactive resource for individuals and
agencies involved in the area
- The RCN and the RCGP collaborate to acknowledge
the aspiration of nurses in the field of homelessness to be
recognised as a specialism with a core curriculum, training
opportunities and qualification
When considering the education and
learning priorities in working with homeless people, the RCGP
recommends that:
- Service users are actively involved in
planning service configurations, delivery, and education and
learning initiativesWorkforce confederations and PCTs work together
in partnership as learning organisations to develop appropriate
education and learning opportunities at all entry levels The extent
and pervasive nature of negative stereotyping is recognised as an
important barrier to good quality primary care and that
appropriately focussed education and learning initiatives are
developed in this area Education and learning initiatives around
homelessness issues should be multidisciplinary in nature Education
and learning opportunities should include diversity training,
methods of risk assessment and dealing with complex needs such as
alcohol and substance misuse and mental illness Continuing learning
and professional development should be focussed on the interfaces
between different agencies
When considering the care of
homeless children, the RCGP recommends that:
- The UN Convention on the rights of the Child
1989, endorsed by the UK Government, which gives all children the
right to the highest level of health possible is recognised and
acted upon at all organisational levels
- The causes of child homelessness which include
family difficulties, domestic violence, immigration and asylum
seeking, abuse and substance misuse are recognised, acted upon and
that appropriate education and learning opportunities are available
for practitioners in the field
- The consequences of child homelessness,
including adverse physical health, poor uptake of immunisation and
preventative services, increased accidents, developmental delay,
malnutrition, psychosocial effects such over activity, aggression,
poor sleep patterns and increased risk of child abuse are
recognised, acted upon and that appropriate education and learning
opportunities are available for practitioners in the field
When considering refugee
homelessness, the RCGP recommends that:
- Training in homelessness issues should include
aspects specific to refugee homelessness
- Extra resources are made available in areas of
high refugee homelessness including particularly adequate
interpreting and translation services
- Agencies work together to promote positive
images of refugees and asylum seekers
Dr Helen Lester
Dr Iona Heath
Dr Nat Wright
Dr Paul Thomas
Fiona van Zwanenberg
On behalf of the RCGP Health Inequalities Standing Group