Abstract

Experience and population health evidence suggests that these are a cohort who “fall through the net” in accessing routine healthcare. At the same time, they are a group with complex health (physical and mental) and social issues.
This work is supported by National and local drivers. The NHS Long Term Plan has made respiratory disease a national clinical priority. Respiratory disease is also one of the 5 clinical areas included in the NHSE CORE20PLUS5 approach, which also aims to reduce health inequity for the most deprived 20% of the population. North Central London population health strategy emphasizes prevention, early identification and proactive care.
Whilst smoking rates are falling amongst the general population, rates amongst PEH are estimated to be around six times higher (tobacco and other substances). Initial scoping work suggested this cohort are unlikely to access quality assured spirometry and as a result are on sub optimally managed.
The pilot brought together healthcare clinicians from primary, homeless health outreach, specialist community and secondary care. The GP Federation provided diagnostic spirometry and smoking cessation support, hostel and day centre staff (trusted partners) also provided invaluable support on the day.
19 PEH attended on the day, a mix of targeted and opportunistic drop ins. Data was collected for how each service was accessed by clients, for example 9/19 undertook diagnostic spirometry (3 positive diagnoses). One patient with reported haemoptysis was discussed at Respiratory Consultant led MDT. 10/19 consulted tobacco dependency service. 10/19 consulted specialist respiratory nurses and physiotherapists. Inputs and impacts were recorded.
Client and staff feedback was also collected. “I haven’t made it to 3 appointments for breathing tests now. I was told I needed another referral. Travelling to places I don’t know can be difficult if I am having a bad day”
Valuable learning will be used to inform a further event which is planned to coincide with offering seasonal flu vaccinations.