Pharmacist Prescribers Working With People Who Are Homeless
The health of people who are homeless is worsening, with the Accident and Emergency (A&E) visits, outpatient non-attendance and drug related deaths increasing. Health services are struggling to engage and meet the diverse needs of this marginalised group. People who are homeless have low rates of healthcare engagement, low uptake of preventative interventions including prescribing and increasing rates of presentation to emergency services.
Assertive outreach is an approach used to engage with those who are unserved or underserved by existing agencies, and who are not able or willing to seek services from those agencies. It involves relationship building, with the outreach service having an ideology of care e.g. social inclusion, and unconditional support, based on strong principles and values.
This project is a sibling project of the Glasgow PHOENIx approach and introduces a Pharmacist independent prescriber (fully integrated with Homelessness Health Service) alongside Street Work team worker, to assertively outreach in Edinburgh city centre and also running regular drop ins at the streetwork hub for health & social care.
- What was the approach?
A pharmacist independent prescriber is partnered with a Streetworks outreach liaison one clinical day per week. On this day together they provide assertive health outreach to rough sleepers and the homeless community in Edinburgh City Centre. The Pharmacist is responsible for medical decisions and health interventions delivered on outreach and prescribes independently on the streets to patients. The Streetworks outreach has up to date knowledge of vulnerable individuals whom may need health support and knows the client group.
The Pharmacist is clinically linked to and supported by the Access Medical Practice team of GPs, CPN, & Nurses. In addition they have an extra two hours distinct from her clinical day in which to undertake clinical follow up time. Although a learning point from this project is that this is not enough - a full half day is needed to ensure capacity for follow up and administration time.
The Streetworks outreach worker leads on directing and introducing the Pharmacist to known begging sites and rough sleeping sites. The worker is well linked into other third sector organisations and helps to improve joint working between teams. There is an additional 1.5 days to provide follow up, housing support, support to appointments, and social prescribing – maintaining links to the wider outreach team and keeping knowledge up to date of the client group and the homeless landscape to inform the pharmacy outreach.
The drop in clinic early on a Friday morning, 7.45am-9.30am has continued and is ideal to engage people as they leave the night shelter or for others that need to access health advise ahead of attending other appointments or work. Clients either present themselves or the staff help the identify people that need support. These people can either be flagged to the GP or the team.
- What was the impact?
There was general health follow up such as spirometry and offered monitoring for this from the streetwork hub as well as GPs. People were supported to access accommodation and offered social prescribing. Over a 3 month period in the drop in at the hub ( 1.5 hours/week), 3-4 people per session seen dealing with issues and the range from acute illness ,physical and mental health issues, substitution treatment, monitoring of respiratory conditions and blood borne viruses as well as onward registration referral to dentist/physiotherapy.
View the key statistics from Glasgow and Edinburgh here.
Read about the experience and outcomes for someone using the service.
- What was the learning?
There is a need to ensure that there is adequate time for administration and follow up for the patients. There is time for this allocated to the Streetworks team; this has recently been increased for the pharmacist. Originally, this was not feasible for the pharmacist due to other commitments, however, as this had changed additional hours have been allocated after reviewing the budget allocated. Minimum 1.5 days for pharmacist and 2 days for the street work element would be needed for ongoing work.
Regular times and days’ work for the client group is important as those that return become aware of when clinics are going to run.