Our journey 2003 - 2013
Past achievements, new challenges
Dr. Les Goldman - Medical Director
Aim
• Review and celebrate achievements over the
past 10 years
• Look forward to new projects and challenges
Growth
• 2003: Bevan House opens - no registered
patients
• Sept 2011: 1,500
• Oct 2013: 2,286 (52% increase in 2 years)
• Growing team
– Admin
– Clinical
• Extra services
Reaching those in need
500
450
400
350
300
250
200
150
100
50
0
Male
Female
• Young patients, male
predominance
• Homelessness 33%
• Seeking asylum 47%
• Patterns of morbidity
– Tri-morbidity
– PTSD
– Hepatitis, HIV
• Patterns of mortality
Understanding health need morbidity
• HIV analysis 2013
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30 HIV + patients
27 Africa 2 East Europe 1 China
8 men 22 women
20 on antiviral treatment
National prevalence 0.15%
Practice prevalence 1.4%
African patients 7%
African women patients 12.2%
• Learning point
– Need for screening in highest risk
groups
Understanding health need mortality
• Deaths analysis 2010-12
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Average age 41 (range 19 to 62)
56% alcohol problems
56% other drug use
45% homeless or temporary accommodation
39% mental health problems
Last seen at practice 0-20mths before (average 5 months)
• Learning points
– Vulnerability to violence
– Loss of opiate tolerance on prison discharge
– Difficulties of encouraging compliance with treatment
Quality of care
• A&E usage
– A&E attendance rate in patients registered for > 12 months half that of
newly registered patients
• Specific quality targets
– Annual health checks for those at risk
– BBV screening
• Education for clinicians
• CQC
– “All the patients were keen to praise the practice and were very
enthusiastic about how valued the service was”
– “This practice provided a much needed, incredibly valuable service”
Team work and partnerships
• Team commitment and
values – Health Hope
Humanity
• Direct partnership working
– Working Women’s Project for
TLC clinic
– Other new services
• Wider networking
– Asylum organisations, street
homeless services
Social Enterprise in Primary Care
• Social Enterprise status Sept 2011
through NHS Right to Request
programme
• Independence, freedom to innovate
• Flexible, alert and responsive
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New opportunities to attract funding
New skills – Board, wider SE network
Responsibility to community
Profit reinvested for community benefit
New developments in the pipeline
Responsive to need, alert to opportunities
Dreams become reality?
An integrated system of homeless care
- a 1st for Bradford
Expected outcomes
Hospital
In-reach
Team
Primary
Care
Centre
Partnership
between health,
housing and
social care
Outreach
Street
Medicine
Team
Intermediate
Care Service
• More appropriate care
• Improved health, housing
and general wellbeing
• Reduced costs
– Shorter hospital stays
– Reduced admissions
– Reduced A&E usage
Hospital In-Reach Team
Bradford Bevan Pathway
• Specialist GP, Nurse & Housing
Support Worker
• Multidisciplinary patient-centred
approach to improve care and
discharge planning for homeless
in-patients
• Work with A&E, other vulnerable
groups
• 2 years funding from NHS
Excellence Innovation & Strategic
Development Fund
Intermediate Care Service
BRICS
• 14 wheelchair accessible units
opening Winter 2013
• On site health, housing and
support services
• “Step-down” facility for homeless
inpatients no longer needing
acute hospital care
• Possible “step-up” facility to avoid
admission
• Capital funding, revenue costs to
March 2014 from NHS Homeless
Hospital Discharge Fund
Street Outreach
Street Medicine Team
• GP, Nurse and Mental
Health Worker
• “meet people in their own
reality”
• Flexible sessions
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Homeless drop-ins
Street work
Mobile clinic
Support for workers
• Funding by CCGs until
March 2015
New premises plans
• Grant and loan from Social
Enterprise Investment Fund
to purchase and refurbish
large Grade 2 Listed city
centre premises
• Room to expand services
and innovate
• Space for partner agencies
• Rental income reinvested
for community benefit
A lot to be proud about
• Make new projects work
• Prove effectiveness to
secure ongoing funding
• Continue to develop in
difficult politico-economic
environment
• Give the disempowered a
voice
• Remain true to our vision
and values
Aneurin Bevan 1897-1960
“We should take pride in
the fact that despite our
financial and economic
uncertainties, we are still
able to do the most
civilised thing in the world,
put the welfare of the sick
in front of every other
consideration”
Feb 1948