Letter from the Chief Inspector of General Practice

Inclusion Healthcare Social Enterprise CIC provides high quality primary health care services for homeless people. This included patients who were vulnerably housed, rough sleepers, squatters or sofa surfed in Leicester. It is based at Charles Berry House which was converted for purpose and provides an excellent city centre venue, close to public transport. It is purpose built with eight consultation rooms and separate entrances for patients and staff.

We carried out a comprehensive inspection on 6 November 2014.

We rated the practice as Outstanding. An effective, responsive and well-led service is provided that meets the needs of the population group it serves.

Our key findings were as follows:

• Patients were kept safe because there were arrangements in place for staff to report and learn from safety risks.
• There were systems in place to keep patients safe from the risk and spread of infection.
• The practice was responsive to the differing needs of its patient population.
• We saw that staff were able to identify and respond to changing risks to patients including deteriorating health and well-being or medical emergencies.
• Patients were treated with compassion, dignity and respect.
• To reduce ‘Do Not attend’ (DNA) rates a health care assistant attended appointments with the patient if requested to act as an advocate.
• The practice had a clear vision to improve the health of vulnerable and excluded groups.
• There was a culture of learning and development.

We saw areas of outstanding practice including:

• Learning from the diagnosis and treatment of the patient who had taken an overdose was shared with the whole team and other external agencies. Training was then provided to external agencies and clinical staff. Information was shared with commissioners and the drug and alcohol team as a safety alert.

• Staff gave examples of how they responded to patients experiencing a mental health crisis, including supporting them to access emergency care and treatment. The practice monitored repeat prescribing for people receiving medication for mental health needs.

• Referral rates to hospital for appointments are high as the patients are homeless people with complex physical and psychological needs. Do not attend (DNA) rates are high but the practice have started to put in place a system for a health care assistant who accompanied patients to appointments if they wished. The health care assistant reminds the patients of the appointment will accompany them and be with them in the consultation room if the patient requests it.

• The practice contributed to funeral costs and memorials for patients who were homeless. They have created a memory wall at theAnchor Centre. TheAnchor Centre is a 'wet' day centre for street drinkers.

• The practice had a primary care plus (PCP) nurse. A PCP nurse works with hostels, local hospitals and in the community. They provide additional support whilst homeless patients are in hospital and take an active role in ensuring that each patient’s discharge from hospital runs smoothly and helps reduce inappropriate attendance at the hospitals’ emergency and urgent care departments. They support patients by accompanying them to hospital appointments.

• The practice used the Human and Environmental Risk Assessment (HERA) risk stratification tool, which helped doctors detect and prevent unwanted outcomes for patients. This helped to profile patients by allocating a risk score dependent on the complexity of their disease type or multiple comorbidities.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice