The care of vulnerable patient groups is quickly moving up the agenda of the government and fledgling GP consortia.
Alongside all the other competing priorities for new GP commissioners, they can now expect to develop services for groups including sex workers, travellers, refugees and the homeless.
At a recent roundtable discussion organised by the RCGP, key figures from the field met to highlight the needs of these groups and how they could be met through improved commissioning.
The group warned that despite the good work being done in parts of the NHS, a major change of attitudes was needed in all sectors.
Mainstream care
Professor Helen Lester, chairwoman of the RCGP's Clinical Innovation and Research Centre, has worked with homeless patients for 20 years.
Professor Helen Lester
She said services for excluded groups had to be brought into mainstream care: 'Why do they have to be seen in specialist units, which just ghettoises the people with these problems - people with huge health needs.
'Let's not just sit around talking about how terrible it all is. Let's require in commissioning that these people come in through the same front door of the building and see the same doctor as everyone else, for the same time or even more time as they have complex needs.'
Professor Lester said this was not just an issue for practices in deprived or inner city areas.
'Every practice will have people with serious mental health problems. We have social exclusion problems in every practice in the land and we have to recognise this in our language when we talk about these issues.'
Dr Agnelo Fernandes, chairman of The Croydon Federation of 17 practices in Surrey, said although local commissioners had tried to tackle services for excluded groups, there was no shared vision with front line practices.
Dr Agnelo Fernandes
'GPs want to look after all people and to do so with equality, but it's a question of empowering them,' he said.
'There are so many practical things that need to be done in order to break down that barrier, for example addressing the huge issue of patient records for these groups. Commissioning is just one of the answers.'
Former RCGP chairman Professor Steve Field, who practises in a deprived area of Birmingham, said simple things such as the attitude of practice staff could be a problem.
'Patient turnover in our area is 35 per cent compared with the national average of 7 per cent, and if a sex worker comes in and has to answer lots of questions from a receptionist, then that can really put them off.
'There can also be a rapid turnover of GPs, particularly if they are trainees, so that can be off-putting as well.'
Quality of care
Head of inclusion health at the DoH, Kate Oakes, said access was just one side of the issue. 'The first step is to give people access to care but then we have to make sure that they receive quality of care once they are in the system.
Kate Oakes
'For example, while 83 per cent of sex workers are registered with a GP, two thirds of them had not disclosed their job to their doctor.'
The RCGP's First5 CPD fellow Dr Clare Taylor, representing recently qualified GPs, said few GP registrars had experience of working with groups in deprived areas, making it difficult to adjust once they started practising.
'This needs to be pushed up the educational agenda,' she said. 'If this is a priority for the profession and every GP needs to be looking out for it, the only way is through professional development.'
Major change in attitude
Jill Matthews, national implementation director for primary care and community services at the DoH, said the White Paper was a huge opportunity for the inclusivity agenda, but required a major change in attitude.
'The commissioning board and consortia need to be clear about their ambition, and truly embody the idea that no one should be left behind.
'We have to actively seek out those that cannot find us and ensure that our services change to meet those needs in the way they deliver, act and respond.'
Northampton GP Professor Simon Gregory said he believed that GPs did want to be more involved in the care of vulnerable patient groups.
Professor Simon Gregory
'This is an opportunity and we as a profession do care. I think it's a case of raising the expectation and we've got to look at the opportunities being provided for us,' he said.
'There is a hunger for it and we as leaders of the profession need to feed that hunger.'
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