Delivering primary care to patients who are multiply-excluded

Talk Code: 
Emily Clark
Professor Nicholas Steel, Dr Tara Gillam
Author institutions: 
Norwich Medical School


City Reach Health services (CRHS) provides primary healthcare services for people in Norwich who find it difficult to visit mainstream GP services such as rough sleepers, sex workers, people seeking asylum and other vulnerable migrants.


• To characterise the population of patients registered at City Reach Health services and the services provided.

• To review to what extent CRHS provides meets the national standards of effective health care provision for vulnerable patients.

• To develop an evidence-based action plan for service development.



• Quantitative data capturing exercise from medical records to define the baseline characteristics of the patients registered at City Reach and services provided.

• Semi-structured interviews with staff and patients to explore the experience of patients, any facilitators or challenges to their care and to understand which outcomes matter to patients, analysed with the Context, Mechanism and Outcome framework.



• Quantitative analysis so far has revealed high rates of mental health diagnoses (87% of patients),increase in demand over the last year (increase of 30% in contacts), and high rates of severe trauma in the homeless population (44%) and substance misuse (70%).

• Interviews with patients and staff showed themes such as the relapsing/ remitting nature of exclusion, the importance of longer appointments and tolerance of challenging behaviour.



• Results show gaps in service provision, such as the lack of service user feedback into the service and clinical capacity.

• The results of these studies will enable comparison of care to the values of the Faculty of Inclusion healthcare and use of a self assessment tool and development of an evidence based action plan.


Submitted by: 
Emily Clark
Funding acknowledgement: 
NIHR CLAHRC I was 2019 'Early Career Researcher' prize-winner at Madingly, Cambridge (January 2019) who will fund my place at Exeter.