On Tuesday January 5th 2021 homelessness charities in Nottingham sent an open letter (below) to the local NHS Clinical Commissioning Group (CCG) expressing their disappointment and concern over the process that has resulted in the imminent closure of the city centre GP practice, Platform One. This practice has been one of the few in the city that has welcomed patients no matter what their circumstances, whether they have no fixed abode, mental health issues, substance abuse histories or have been rejected or barred from other practices. As such it has become the go-to practice for many of the most vulnerable and marginalized patients in Nottingham.
Members of the Framework Street outreach team explain,
Platform One is the only doctors’ surgery that can take new patients in and treat new patients instantly when they present.
We have used this advantageous resource on countless occasions over the years it has been available, as the work we do with rough sleepers often requires us to access immediate and significant First Aid. On these occasions we are able to both escort and send rough sleepers to the site regardless of where in the country their local connection may be and they can be seen and receive treatment from the diligent and hardworking medical professionals therein.
Without this invaluable resource we would be further marginalising an already marginalised group and putting our services users at risk of great harm, risk of illness, infections and contamination and injury – this group are already at risk of injury and ill health due to their vulnerable and chaotic lifestyle, which has been compounded further by the risk of contracting Covid19. We would implore the CCG to rethink this decision and consider the knock-on effects of this move.”
Ben Talbot, CEO of the Friary drop-in centre in West Bridgford added, “Since it was established, Platform One has shown both an enthusiasm and willingness to register and support people who many other practices consider to have too much in the way of complex needs. We have welcomed their proactive and non-judgmental approach, which ensures that those who register with them have a far better chance of positive outcomes. They would be a real loss to the local area”.
Concerns over the lack of consultation throughout the process so far were raised by the Health Scrutiny Committee of the Nottingham City Council in December 2020. However, these concerns came too late to affect the outcome of the bidding process for the new contract.
It is the hope of the voluntary sector that the CCG will now act in an open and collegiate manner to ensure that the good practices that patients experienced at Platform One will be continued by the new provider, the identity of which has not yet been released by the CCG.
Dan Robertson from the Nottingham and Notts Refugee Forum, who first alerted the charitable sector to this issue, said ”Platform One has always gone above and beyond to help vulnerable patients who have not been able to register with other GP practices. At a time when health inequalities are being brought into sharp relief by Covid-19, I would like commitments from the new provider and the CCG that no patient will be left behind by these changes.
Specific examples of good practice at Platform One highlighted by support workers from Emmanuel House Support Centre include:
- Quick responses: A client presenting at Emmanuel House straight from prison was registered with Platform One and they very quickly got him back on his Mental Health medication.
- Wider engagement: A homeless client was provided with written evidence of his ongoing health needs from a Platform One GP which meant he was classed as a priority need and could be housed more quickly. This is something that a support worker cannot prove without healthcare input.
- Holistic approach: Platform One sees many clients in conjunction with the Wellbeing Hub which allows very vulnerable clients to have their physical and mental health needs addressed at the same time as their addiction issues and methadone prescribed.
- Respect and empathy: The staff from reception to assessment to consultation and treatment demonstrated sensitivity, respect and empathy for clients and communication between the various aspects of the service is excellent and instills confidence in patients.
- Accessibility: The building is easily accessible, and the range of services delivered from maternity to mental health to COPD and asthma are also accessible. The diversity of the staff helps to make the service welcoming and accessible to the diverse homeless community.
An additional concern raised by Framework Street Outreach Team is the effect on Accident and Emergency services in the city: “In relation to our service users Platform One has always been an excellent service that is easy and convenient to register with and has really good GPs with a professional understanding of the mental and physical health issues related to rough sleeping. It is ideally placed for those that are living or rough sleeping in the city centre. If it were no longer there it would surely lead to an increase in the overburdening of other surgeries and especially A+E at the QMC”
Our letter to the CCG was sent in the hope that it would lead to effective consultation of the charitable sector to ensure that the needs of their clients are fully met by the new provider. This is a concern shared by Lilian Greenwood, MP for Nottingham South, who said “The Platform One GP service is rated Outstanding by the Care Quality Commission and enjoys an excellent reputation amongst those who support homeless people for the way in which its staff work with some of our city’s most vulnerable and marginalised people. It is vitally important that this record of excellent care is not disrupted by the change of provider. I fully support the call from the Nottingham Homelessness Voluntary Sector Forum for the CCG to ensure that homeless people in Nottingham who rely on Platform One for healthcare are fully considered and supported before, during and after this transition.”
Open letter to Nottingham and Nottinghamshire CCG
The member charities of the Nottingham Homelessness Voluntary Sector Forum (listed below) wish to express their disappointment at the closure of the NEMS/Platform One GP practice and their serious concerns about the lack of consultation regarding this change for their client group.
For many years the Platform One GP service run by NEMS has provided excellent care for some of Nottingham’s most vulnerable and disadvantaged residents. This includes those who are homeless and those with particular difficulties such as mental health issues and drug and alcohol dependencies. Although not the only inner city service to welcome these patients , Platform One has often been one of the few NHS practices that would accept these patients regardless of their problems and situations. Staff, from receptionists to nurses and doctors, have cared for these patients with kindness and great expertise.
While we understand that, at the end of the current contract for this practice, the CCG found it necessary to open a procurement process that included a substantial reduction in the money provided per patient to run the service, this change of provider should have involved proper consultation. As has been publicly demonstrated through the NCC Health and Scrutiny Committee, consultation was woefully poor. A key consequence of this lack of consultation is that the impact of these changes on our clients, those who are homeless or with particular needs as described above, were not properly considered. We therefore remain concerned that the new provider that has been appointed by the CCG, still without substantial scrutiny, transparency or consultation, will not be ready to provide the same level of care for these people that they have come to rely on from Platform One.
We therefore ask that the following specific issues be addressed:
- Consultation: as agreed at the Health Scrutiny Committee of December 17th 2020, voluntary sector organisations whose clients are affected should be included in the committee that informs the mobilization of the new contract. This committee should include representation from groups who represent those with Severe and Multiple Disadvantages, refugees and asylum seekers, the homeless and other marginalized patient groups. It should also include representation from outside of the city (and the new practice boundaries) as clients in these areas were patients at Platform One and to address issues around patients moving in and out of the new practice boundaries (see below).
- Access: Platform One generally accepts any patient, including those turned away or banned from other practices. We ask the CCG to ensure that the new provider agrees to a flexible and ‘open’ registration process similar to that operated by Platform One. The voluntary sector organisations will also aim to accompany clients to their new GPs wherever possible, to support them but also to gather intelligence as to how the new processes work. We understand that it is the stated view of the CCG and NHS that no homeless person should be turned away by any practice.
- Boundary: Platform One operated effectively with no boundary so that any client could access the service. The proposed boundary for the new practice means that anyone with the new practice would be required to move to another practice if they move outside of that boundary. This is a particular issue for patients in unstable situations who might have to move around, especially those needing mental health support. We ask that the new provider should agree a flexible model that takes account of our clients’ vulnerabilities and special support needs to allow then to remain with the practice when their residence might be temporarily outside of that boundary.
- Expertise: it is the view of this group that many GPs and practices where patients from the Platform One patient list are being ‘dispersed’ will struggle to deal effectively with this client group. We suggest that patients who are homeless, have SMD, refugee and asylum seekers need to be seen as ‘mainstream’ rather than ‘marginal’ patients. This will require appropriate training and education of GPs and practice staff to understand all of the issues that surround these circumstances and how best to address them. We ask that this training should make good use of the vast expertise amongst the key staff such as reception staff, nurses and GPs of Platform One and the two other key city centre practices who deal with these patients (Windmill Practice and Family Medical Centre)
We hope that we will be able to work with the CCG and the new providers to ensure that the services for our clients are at least as good as they were with platform One.
Matt Atkins (Director, Nottingham and Notts Refugee Forum)
Jessica Brannan (Project manager, Broxtowe youth homeless)
Beatrice Giaquinto (Interim Manager, Nottingham Arimathea Trust)
Dave Goold (Service Broker, The Big Issue Foundation)
Jane Henson (Chair Nottingham HOST)
Jo Jepson (CEO-Base 51)
Liam O’Boyle (Partnership Officer, Diocese of Southwell and Nottingham)
Andrew Redfern (CEO Framework Housing Association)
Paul Scotting (Chair of the Nottingham Homelessness Voluntary Sector Forum)
Sharron Spowage (Project leader, Safe in partnership with The Salvation Army)
Ben Talbot (CEO, The Friary drop in centre for the homeless)
Megan Towers (Project leader, Open Homes)
Denis Tully (CEO, Emmanuel House drop in Centre for the homeless and the Nottingham Night Shelter)
Kay Wainman (Chair of Trustees, Jericho road)