Letter from the Chief Inspector of General Practice

The service is provided by BrisDoc Healthcare Services Limited who have operated the Homeless Health Service since 1 October 2016. We carried out an announced comprehensive inspection at Homeless Health Service on 5 & 6 June 2017. Overall the service is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• The service implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients. For example, they held a user engagement day to review how patients viewed and accessed the service. This resulted in a plan to change the physical access and reception to the service.
• The service used innovative and proactive methods to improve patient outcomes, working with other local providers to share best service. For example, they worked closely with the local council homeless strategy and other providers to act on intelligence to seek out and offer outreach support to newly reported homeless people.
• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The service worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, they took services to where they were needed which included offering home visits to people in hostels and those whose ‘home’ was on the street.
• Feedback from patients from the Friends and Family Test was consistently positive.
• The service had good facilities and was well equipped to treat patients and meet their needs. The service showed determination and creativity to overcome obstacles to delivering care. The service took part in seasonal events and had worked with the Julian Trust to provide health care and support at the shelter for the Christmas week.
• The service actively reviewed complaints and how they are managed and responded to and any improvements needed as a result.
• The service had a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
• The service had strong and visible clinical and managerial leadership and governance arrangements.
• The service had clearly defined and embedded local and organisational systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. GPs, nurses and locum GPs were skilled in caring for the patient group and had qualifications and experience in caring for patients with drug and alcohol addictions, challenging behaviours and supporting patients who were homeless or vulnerably housed.
• GPs working at the service took part in shared care prescribing for 70 patients who were part of the Supervised Methadone and Resettlement Team.
• There was a proactive approach to understanding the needs of this vulnerable patient group. Staff acted as advocates and delivered care in a way that meets patients’ needs and promoted equality. Patients told us they were treated with dignity and respect and were involved in their care and decisions about their treatment. Patients were respected and valued as individuals and were empowered as partners in their care. The staff had a culture of ‘unconditional positive regard’ for patients and no one was considered beyond help.
• Patients we spoke with said they found it easy to make an appointment with the service and said there was continuity of care, with drop in appointments available the same day. An average of 400 patients per month had used the service over the last twelve months.

We saw several areas of outstanding practice including:

Staff worked collaboratively with many other providers, both within the centre and externally, to ensure the vulnerable patient group was supported to receive coordinated care which met their needs. Service staff used opportunistic, innovative and efficient ways to deliver more joined-up care to patients. For example, the service worked with the University College London Hospitals’ TB (tuberculosis) ‘Find and Treat’ team, as part of a two-day initiative where 200 homeless people in Bristol were screened for tuberculosis.

Professor Steve Field

CBE FRCP FFPH FRCGP

Chief Inspector of General Practice