Route to regeneration

In Peterborough, they’ve been doing some rearranging.

Ian Anderson, director of adult social care at Peterborough
Council, sits on the executive board of North Peterborough Primary
Care Trust.

Similarly, Sylvia Sew, the trust’s intermediate care lead, is now
managed by the council’s social services department.

The trust and its south Peterborough counterpart have moved on a
long way from the days when their main concern was local GPs. South
Peterborough runs comprehensive children’s services, including
employing child protection workers and offering speech and language
therapy. North Peterborough works with police and the housing
service to make sure refugees are looked after.

The two trusts are part of a nationwide trend to involve primary
care services more in tackling social problems. When politicians
push for social regeneration, increasingly they are looking to see
what PCTs are doing about it.

The trend stems in part from The NHS Plan, published in July 2000,
which identifies divisions between health and social care as a
major factor in confusing service users. It has set financial
incentives for meeting targets: a performance fund for health
bodies – £500m in the year 2003-4 – and a similar carrot for
social services – £100m from this year.

What this has meant, says Hazel Smith, head of service delivery and
nursing at North Peterborough’s community services directorate, is
that trusts have had to radically change how they work.

“We are now line-managing the social workers, as they’re the ones
that go into the home.

“In terms of this (crossover) agenda, you need to look at things
like our health partnership board. We’ve got voluntary sector
representatives, health representatives, the local authority,
social services,” Smith says.

From this base, services for refugees, care of diabetes sufferers
and Sure Start programmes sit alongside each other.

In Wansbeck, Northumberland, one of Britain’s most deprived areas,
new joint health and social care funding has enabled each of the 14
practices there to have a social worker attached. This means more
“seamless” care and a chance for both sets of professionals to get
a full picture of the clients’ circumstances.

GP Dr Peter Sanderson says there are other side benefits. For
example, GPs often struggle with patients failing to take the
prescribed medicines.

“Before, we wouldn’t have thought to talk to social services about
that. But now we’re finding that social services say ‘we go into
people’s houses and they’ve got unused drugs and we didn’t know
what the policy is’.”

An advantage in the new arrangements has been a chance for health
care to refocus its services to address social problems.

Drug misuse, homelessness and refugee care are some of the more
common areas trusts have developed services around, as the client
groups are easily identifiable. There are special primary care-run
drug services in Leeds; health care projects for homeless people in
Edinburgh, London, Northampton and Exeter; and surgeries catering
only for refugees in Derby, Leeds, Stockton and Birmingham.

A tool many trusts have used is Personal Medical Services (PMS), an
alternative contract for GPs that allows projects or surgeries to
tailor their services to local need.

In Northampton, the then primary care group found it hard to get
health care for homeless people, those with drug misuse problems
and travellers. But in 2001, GP Catherine Hewitt and nurse
Bernadette Whoolley set up the Maple Access Project, a PMS scheme
specifically for these groups. Hewitt says she would not have
switched to PMS to provide “ordinary” care but that the contract’s
flexibility has enabled the project to serve those groups.

“We’ve been incredibly successful. The numbers have come in, all
the other agencies are happy and I think the other GPs appreciate
us,” she says.

Projects such as this could be just the beginning for primary
care’s role in social care. The 70 per cent of GPs not on PMS
contracts are considering a new deal that would give PCTs
unprecedented scope to design and commission local services.

The contract will allow trusts to create “local enhanced services”
and commission doctors and other primary care professionals to
deliver them. In other words, they can use budgets to provide these
services to meet whatever local need there is.

Homing in on homelessness   

Dr Philip Reid and Dr Simon Ramsden run the Great Chapel Street
health centre in London’s Soho as a branch surgery of their Notting
Hill practice, treating solely inner-city homeless people. 

Although the centre has been open since 1977, the GPs switched
over to a Personal Medical Services (PMS) contract last year,
because of its funding flexibilities. It has allowed them to employ
another doctor, whose main focus is on managing homeless patients’
chronic diseases. 

The centre also has a social worker to help with housing and
money, a dental clinic and a psychiatric service. Consultant
psychiatrists work there three times a week, and there is a
full-time community psychiatric nurse with a specialist interest in
drug and alcohol abuse. 

However, Dr Reid says, dealing with medical problems can be
difficult when patients are in “hopeless” or “chaotic” situations.
So the practice has set up Wytham Hall, a residential care home for
homeless people. 

“You can pull them out of this situation – provide
accommodation, food and medical attention – and then use that
opportunity to look at the social issues behind the homelessness,”
he adds.

Softer landing for refugees   

In April, North Tees Primary Care Trust opened the “Arrival”
practice in Stockton, which treats only newly arrived
refugees. 

The trust has employed Dr Paul Williams, a GP with experience
and specialist training in treating refugees. The practice, which
can take 500 patients, can give refugees 20- to 30-minute
appointments and do full health assessments, immunisation checks
and other health screening.  

The practice also refers refugees to other services, such as
counselling for problems endured in their homeland and housing, as
well providing advice to other health workers on treating
refugees.  After six months at the practice, patients will be
integrated into other practices. 

Dr Williams says one aim of the project is to relieve the heavy
workload on other practices that newly arrived refugees
cause.  

The trust says refugees have no idea how the health service
works or how to register at a practice, while many of them distrust
authority figures, such as doctors. It hopes that providing a GP
with special training in treating refugees will help.

Easing in intermediate care 

Over recent years, the government has placed an increased
emphasis on enabling older people to live in their own homes for
longer.  

Primary care is playing a major role in making this a reality,
as two successful schemes in the South West illustrate.  

The Carrie project (Crisis Assessment Rapid Re-ablement
Intervention in the Elderly) has aimed to prevent unnecessary
admissions, promote independence and prevent admission to long-term
care. Covering all the older patients registered with GPs in the
south Devon towns of Torquay, Paignton and Brixham, it gives quick
access to assessment, rehabilitation, equipment and services. 

Carrie has a budget for hiring private nursing home beds for
acute patients. A review of the scheme found that 62 per cent of
patients were still living independently after one or two
interventions.  Meanwhile in Bristol, the Hospital Discharge and
Admission Prevention project focuses on the patient’s home,
assessing safety issues and possible home improvements, repairs and
adaptations. 

GPs, primary care staff, hospital staff, social workers and
community health care professionals refer patients to the
scheme. 

Of the project’s first 126 patients, 38 per cent were at risk of
a hospital admission but stayed at home. The remainder were able to
return home after an admission.