The GP practice sharing data to transform care for homeless people

Steve Benson* is happy. He’s just come out of a a 10-minute consultation with a GP he has never met, yet she was able to instantly pinpoint the help he needed. Thanks to the data sharing system being pioneered at BrisDoc, Bristol’s homeless health service, he didn’t have to go over his story yet again.

For this 45-year-old, whose home is a tiny tent in Bristol’s city centre, this successful session is a big deal. Benson lost his house, job and children when the traumas of his army past sent him careering into alcohol and drug addiction. He needs urgent help for a range of complex conditions but, like many rough sleepers, rehashing his story could be enough to trigger further self-destruction.

“You get so sick of retelling your story. But this time the GP could see my notes, and she used the entire time with me to chat about my mental state,” says Benson. “I really found that helpful. Now we’re talking about counselling.”

Benson and the other homeless patients at the Compass Centre, near Bristol’s main bus station, are seeing the benefits of an ambitious data-sharing scheme that was introduced in October 2016 and is being developed at BrisDoc. The aim of the scheme is to pool all available information from medical, psychiatric, social agencies and prisons to enable doctors to work effectively with patients.

Bristol has the second highest number of rough sleepers in the UK, after Westminster. The number of people sleeping rough in Bristol is 74 according to the most recent count. Nationally, the number of rough sleepers has increased by 51% over the past two years, from 2,744 to 4,134.

If BrisDoc gets the data sharing right with this complex group of patients, the GPs involved believe the model could be applied across the NHS. “The pioneering work being done by the BrisDoc homeless health service shows the benefits that integrated care can bring,” says Dr Shaun O’Hanlon, chief medical officer at Emis Health.

Building the existing data platform has been made possible by combining information from two main systems – the Emis data-sharing platform used by 106 GP practices in Bristol (covering about one million patients) and Connecting Care, a local electronic patient record allowing health and social care professionals in Bristol, South Gloucestershire and North Somerset to access outline NHS patient information.

Before October, that information would have taken hours to collect on the phone, faxing and rifling through papers. Now GPs can see whether a person has been admitted to hospital (and to which ward), how many times they have been to A&E, and whether there are any missed or imminent outpatient appointments.

Dr Mike Taylor, lead GP, is passionate about developing service-specific auto-populating templates for each patient depending on which part of the system they end up in.“In this siloed world, this is something of a miracle,” he says. “The vision is to have a complete, up-to-date picture of our patients. Up to now we have been dealing with an old jigsaw, with pieces missing and no clear image on the front to help us put together the pieces.”

Taylor gives the example of police or paramedics being called to a street dweller wandering drunk through rush hour traffic. A glance at the data platform can indicate whether this person is known to mental health teams, which would lead to a referral there and avoid unnecessary sectioning or a night in police cells.

“These are not feckless joy riders,” he insists, although he admits he’s always on the alert for a physical attack. “Every time you go deep with a homeless person you find out that they have been abused senseless and cannot cope with their pain. A marker of a civilised society is how we deal with those who are down on their luck.”

Adult and child protection data is the most recent addition to the platform. Now Taylor is pressing for more complete information on mental health, dental treatment, prison and housing history, as well as end-of-life plans for each patient. He also wants ambulance, police and triage teams to have access.

For David Ingerslev, rough sleeping service manager for St Mungo’s, the electronic platform has been transformative. “Before its introduction, I have seen support workers spend a day trying to trace a client, only to find out that they are in hospital,” he says. “Now that link can be made in five minutes.”

*Not his real name

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