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Vulnerable group commissioning guide launched by RCGP

Vulnerable group commissioning guide launched by RCGP


Urgent action is needed to prevent sex workers, Gypsies, Travellers and homeless people from falling through the gaps in the healthcare system, the Royal College of General Practitioners (RCGP) claims. 

The RCGP, together with the Department of Health (DH) has released commissioning guidance for health and wellbeing boards and clinical commissioning groups (CCGs) which champions mobile units and clinics, and other outreach facilities. 

Improving access to health care for Gypsies and Travellers, homeless people and sex workers, states that cultural awareness training for frontline NHS staff dealing with Gypsies and Travellers is key.

The report also calls for:

 - More ‘one-stop’ healthcare hubs where vulnerable groups can receive multiple services in one place at one time.

 - Greater community engagement to allow vulnerable groups to have their voice heard and develop support networks.

 - More localised decision making for commissioners, who should seek greater collaboration with vulnerable groups to deliver mutual health and financial benefits.

 - More communication and joined up working between health, social care and voluntary services targeted at marginalised groups. 

 - Greater integration between health and housing services to identify and treat health problems associated with poor living conditions.

The report claims that sex workers are gradually moving off the streets, making them harder to contact.

GP commissioners should consider paying for mobile units, dedicated clinics and one-stop shops in urban areas, to allow the thousands of people who work in the sex industry to have better access health services, RCGP recommends.

Bringing services directly to the thousands of people who work in the sex industry, will often be an effective strategy to ensure they undertake the first step to address their health needs, for example on-site testing, says the report.

Life expectancy

On the issue of providing health services for homeless people, the paper states that the impact of rough sleeping on the wider health and life expectancy of individuals is well recognised. A recent evaluation by Crisis assessed the average life expectancy as being 47, as opposed to 77 for the general population.

The report says that to help tackle the health needs of homeless people, CCGs should put an emphasis on outreach services, stating that outreach "is a very important element, as it not only provides an opportunity for initial engagement on the streets, but also supports new rough sleepers before they become entrenched in the lifestyle."

And 42% of English Gypsies are affected by a long-term condition, as opposed to 18% of the general population.

The paper adds that there a range of contributing factors to the poor health outcomes of Gypsies and Travellers, and the difficulties in accessing services. These include low levels of literacy, together with stigma, poor access to health information and some widespread health-beliefs which increase the likeliness that they will not seek treatment.

RCGP chair Dr Maureen Baker, said: “Under the Health and Social Care Act 2012, commissioners of healthcare in England now have a duty to reduce health inequalities in access to services and outcomes.

“It is vital that commissioners put the needs of forgotten and disenfranchised groups at the heart of their commissioning strategies.”

A Department of Health spokesperson said: “With the implementation of the 2012 Health and Social Care Act, we have a unique opportunity to try to get things right and break the circle of exclusion for some of the most vulnerable in society.

“In this changing landscape, with GPs becoming commissioners as well as providers of care, we need to make sure that some of the most vulnerable in society remain high on the agenda.”

The guidance was funded by the DF Inclusion Health programme. The full report is available to view on the RCGP website


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