After six years of saving lives, a GP practice helping hundreds of rough sleepers has been shortlisted for the London Homelessness Awards.
Located at The Margarete Centre near Euston station, the GP Outreach Programme at Camden Health Improvement Practice has over 600 registered homeless patients, a number which fluctuates up to 800 at points throughout the year.
When Dr Gary Coleman sat down with his team at the NHS practice in 2015 to conduct an audit of causes of patients’ death over the preceding ten years, they noticed a striking fact: that the average life expectancy of the homeless patients they dealt with was a mere 47 years old.
Rather than being an outlier the team was shocked to learn that this was the national average life expectancy for homeless people.
Despite this “horrific” statistic, Dr Coleman recalls that at the time, “we thought we could do something to change it”. The audit had shown that the causes of death were preventable. They ranged from infections, over-dosing and bleeding out to suicide and liver diseases.
The challenge for the practice, which treats homeless people from the entire borough of Camden along with some from Islington and Hackney, was not in treating these causes of death. The problem was making sure their registered patients, mostly male and in their fifties, were actually engaging with the service.
As Dr Coleman points out, “a lot of the clients have had trauma since childhood”, explaining why many do not get medical help when they can. “They have, not unreasonably, learnt to not trust the establishment or authority figures, perhaps due to their previous experience in children services or more recently dealing with the police.”
To overcome the problem of homeless patients dying as a result of disengagement with services, Dr Coleman started the GP Outreach Programme. After using data analysis to create a list of those patients most at risk of dying, he began going out on his bike once a week, trying to find homeless patients across Camden’s hostels and streets to perform check-ups and simple treatments.
“During the visits the main thing is vigilance, and to look for problems like infections, risks of suicide, blood clots, which might become emergencies. Cognitive impairment is one thing, in the past a homeless person might assume to have been intoxicated, but over months you get evidence that they have early on set dementia or are developing psychosis in their fifties. These patients would have been missed otherwise.”
While Dr Coleman is keen to point out that the programme’s success is built on multi-disciplinary teams both at hostels and at the practice, the fact that the outreach consists of “just me on my bike” has proved crucial to building trust with the patients over time.
“Anything we can do to make life easier for the patient is a good thing. You present yourself as someone who’s easy to talk to and there for them, and if there’s a minor issue they have which I can treat, that trust starts to build. If they don’t want to speak or engage when I first visit, I pop back in a month to check in on them.”
This commitment to the outreach programme, and the respect Dr Coleman holds for his patients, has led to stunning results. Since 2015, the average life expectancy of homeless patients in Camden has risen from 47 years to 54. At the same time nationally, the life expectancy of homeless people has disgracefully fallen, from 47 years to 44.
“Anecdotally, we just knew it was making a difference. For example, we finally started engaging one patient who had renal failure but had not been on dialysis, three or four years later they were still alive, whereas before they wouldn’t have been.”
While to onlookers the sight of a doctor reaching vulnerable patients on his bike may inspire images of Che Guevara’s The Motorcycle Diaries, to Dr Coleman medical outreach was nothing new.
“I used to be an army doctor, so I suppose we were used to treating people remotely. I’ve toured Afghanistan, Bosnia, and been in terrain such as the Arctic or jungles - so doing something slightly novel wasn’t unusual to me. All I needed was my diagnostic kit.”
Given the simplicity of the outreach programme, if the practice wins the cash prize “expansion would be the ideal”.
“I’ve done a lot of presentations about the project to GPs across London, lots of whom are interested and would love to replicate it, but they could never get it funded.”
“Essentially the only cost is a GP’s sessional rate, if they already have a diagnostic kit and a bike. Two sessions a week covers a borough with 800 registered homeless patients.”
Dr Coleman recognises that to significantly reduce homelessness, change needs to take place on a “socio-political level”. But with characteristic modesty, he says his outreach programme is “useful”. For homeless patients in Camden, it has proven to save lives.
The London Homelessness Awards will take place on 14th October at the Union Chapel in Islington. To find out more visit http://www.lhawards.org.uk.