healthcare
Seeking healthcare can be daunting
for homeless people. DDN visits a
practice in north London that takes
every opportunity to engage
foot
door
A
in the
‘W
e haven’t touched the sides of the people sleeping on the
streets around here. Everybody comes to Camden, they come
to Euston train station, they come to Kings Cross, there are
millions of tourists marching up and down Euston Road all
the time. So if you want to beg, it’s a good place to be.’ Paul
Daly is the practice manager at Camden Health Improvement
Practice (CHIP), an NHS service run by Turning Point which provides health services
to homeless people.
Walking from St Pancras and past Euston on the way to CHIP means navigating
through people of all ages and nationalities, sitting on the street and in doorways.
As a drop-in health practice, CHIP welcomes all of them without any need for ID. If
you are homeless you can make your way to 108 Hampstead Road and join the
morning queue.
At 9.20am doors open and the first nine patients are seen by the doctor. ‘That
doesn’t sound like a lot, but they tend to be very complex,’ says Daly. If you have an
emergency you can fill out a form and they will squeeze you in; otherwise you will
need to turn up again the next day. Appointment slots are supposed to be 20
minutes per patient, but often run way beyond that. ‘We don’t restrict patients to
one problem, but there’s a limit to what you can do,’ he says. ‘Some of the patients
don’t present very often, so they’ve stored up a whole set of issues and we can’t
manage them all.’ The practice has 800 patients at the moment – an increase of 25
per cent in the last two years.
An important routine for each new arrival is the comprehensive health check,
lasting around 45 minutes, which includes tests for HIV and hepatitis B and C. This
is seen as a golden opportunity to engage, explains Daly. ‘A lot of these patients
don’t go to a GP at all – they let themselves get so ill they go straight to hospital and
it’s an endless cycle. So at least if they’re coming in here and getting their primary
care managed, they have a better chance of stopping that from happening.’
The small team has one and a half doctors and two full-time nurses. They feel
very lucky to have the support of a volunteer GP who used to work at the practice
and comes back twice a week to do medical reports. In common with everywhere
else, budgets (and space) have been squeezed. There’s no longer room for the
10 | drinkanddrugsnews | July/August 2018
clothing store, apart from some socks
and gloves. Strong partnerships with
local hostels and drop-in centres have
become more important than ever.
A doctor from CHIP goes out on his
bike twice a week to visit the hostels and
find ‘the really entrenched people’ who
won’t come to the centre, maybe
offering a prescription as an incentive to
engage. Five or six years ago they were
more of an outreach service, running a
clinic at each hostel once a week. But it
was an expensive way to run the service,
needing double the staff and a lot more
kit – and no guarantee that patients
would be in the right place at the right
time to see the clinicians.
The current model allows hostels to
send their residents over to CHIP for
treatment and holistic care – and the
support works both ways. The area has
built up a network of specialist support
through its drop-ins and day centres, so
there are places to refer young people,
sex workers, and arrivals from other
countries who might need all kinds of
help. Peer support is also close at hand
through the charity Groundswell, who
will take people to appointments –
invaluable help since funding is no
longer available for the team’s in-house
‘navigator’ post.
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