The development of GP clinics for marginalised groups

Problem

The Partnership for Health Equity (PHE) was established in 2013 seeking to improve primary care for marginalised groups in Ireland. It was hoped this could be achieved by educating GP trainees and medical students, conducting research and the direct provision of GP care for marginalised groups. Access to free healthcare in Ireland is based on means and there is an ‘opt-in’ system of medical card registration. The vast majority of marginalised patients are eligible for medical cards on the basis of means yet they often face many other barriers to actually accessing care. This presentation will describe the process of exploring the needs of specific vulnerable groups and their access to health care in Limerick city and the subsequent establishment of a low-threshold GP clinic for such patients.

Approach

A stakeholder mapping was carried out to identify existing services, their connections and their inclusion criteria. A brief stakeholder analysis was then conducted to gauge the influence and importance that various groups had in relation to the proposed project. This was informed by 34 consultations over a ten week period with a purposeful sample of service providers (from both the statutory and voluntary sectors), homeless and drug using clients and their families. The mapping and analysis were carried out using internationally recognised methods.

Findings

All stakeholders consulted were in favour of the establishment of a dedicated service for homeless people and drug users. While there was a high level of medical card coverage among these groups, many faced barriers to actually receiving GP care. These obstacles included the breakdown of the patient-GP relationship and frequent change of patient address. The stakeholders suggestions for services that should be provided included vaccination and blood borne virus testing, addiction assessment and wound care. The clinic was established in April 2014 and has run twice weekly since then. In this time over 1000 GP consultations have been conducted. Patients present with a wide range of conditions including undiagnosed hepatitis, abscesses and severe psychiatric issues. Patients report feeling more comfortable attending this clinic than mainstream services. The drop-in nature of the clinic and having experienced key workers on site also promote engagement.

Consequences

Marginalised groups, particularly homeless people and drug users have been shown to benefit from targeted GP care. We analysed the health services available to this group and recorded issues that need to be addressed. We then developed and began providing a service tailored to these needs. The service which was developed to address the gaps in service provision for vulnerable group in Limerick was successful in removing many barriers to care. This of model could be widely adopted to increase access to primary care for vulnerable groups.