Our journey 2003 - 2013 Past achievements, new challenges Dr. Les Goldman - Medical Director.

Our journey 2003 - 2013Past 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

• 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• 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– 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

• 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 opportunitiesDreams become reality?

An integrated system of homeless care - a 1st for Bradford

Expected outcomes•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 ServiceBRICS

• 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 OutreachStreet Medicine Team

• GP, Nurse and Mental Health Worker

• “meet people in their own reality”

• Flexible sessions– 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

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