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Provision of care for vulnerable people
The CQC now inspects and rates practices against six population groups – older people; those with long-term conditions; mother’s, babies and children; working age; people living in vulnerable circumstances, including people with a learning disability ; and people experiencing poor mental health , including dementia. This article, the fifth in a series of six, will address the ‘people living in vulnerable circumstances, including people with a learning disability’ population group and how we could improve the service we give to them.
This particular patient group includes people whose circumstances may make them vulnerable. A number of different groups of people may be included in this demographic because they live in particular circumstances that may make it harder for them to access primary care, or mean they are more at risk of receiving poor care.
The CQC will focus on assessing provision of care for patients in this group, often including:
- People with a learning disability
- People who are homeless
- Other vulnerable people including travellers, vulnerable migrants and sex workers
How will the CQC assess services provided?
When considering this group, CQC inspectors will focus on access to general practice services generally, rather than physical access to a practice for an appointment. This will include registering with the practice, as well as the ability to book appointments and receive services.
Since the Deprivation of Liberty Safeguards (DoLS), part of the Mental Capacity Act, were introduced in 2009, more adults than ever in care homes and hospitals who lack mental capacity to make decisions about their care are being protected. The CQC will assess the practice staff’s general understanding of, and willingness among providers to protect the rights of individuals, and encourage external scrutiny of their care when a vulnerable person might be deprived of their liberty.
How to achieve a Good or Outstanding rating
People with a learning disability
Practices should hold a register of patients living in vulnerable circumstances, including those with learning disabilities. Practices should regularly carry out health checks for people with learning disabilities and offer longer appointments for them if necessary. Practices whose staff knows their vulnerable patients well are often able to identify a person in crisis. Examples of outstanding care could include patients in vulnerable circumstances who had been identified and staff had intervened to provide help, arranged appointments and worked in close partnership with other health and social care professionals to assist them. These practices often work regularly with multi-disciplinary teams in the case management of vulnerable people.
Practices should consider signposting vulnerable patients to various support groups and other organisations. Staff should know how to recognise signs of abuse in vulnerable adults and children, and be aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in and out-of-hours.
People who are homeless
Practices could consider having an active carers’ support group which would provide a social network and support for isolated and vulnerable patients. This may also provide opportunities for vulnerable people to build networks within the community. Practices may have contact with their local women’s refuge and short-term housing providers, and ensure that the needs of these patients are identified and met. Joint working arrangements could be put in place to support patients with drug and alcohol addiction, as this often leads to improved outcomes for patients who are also homeless.
Travellers, vulnerable migrants and sex workers
Patients for whom English is not their first language should be offered interpretation and translation services. Some practices in particular localities may find it beneficial for key staff to attend ethnic minority awareness sessions to ensure awareness of communication difficulties. Nursing staff could undertake additional courses to provide them with the skills and experience to undertake numerous screening programmes for sex workers. This would provide a team of skilled communicators to build a trusting rapport with these vulnerable patients. Practices could also show data of their success in screening patients for sexually transmitted infections, such as chlamydia screening, when compared with the local and national statistics.
CQC reports highlighted one particular practice that was rated as outstanding because they identified that there was a high percentage of young families, some of whom lived in a deprived area, registered with them. Fundraising at the practice provided additional support to these families, including a transport fund, which was accessed for patients at times of need. During the year, 32 patients out of the total of 3,633 had benefitted from this fund.
Another outstanding example included a practice who recognised the dichotomy of wealth and deprivation that exists in their local area. The practice held food bank vouchers for those who were in need and worked in partnership with a local community body which aims to alleviate hunger and poverty.
Key areas for action
These are actions which practices should consider to evidence that they are meeting the needs of vulnerable people and what outstanding provisions may also be offered:
- Hold a register of patients living in vulnerable circumstances, including homeless people, travellers and those with a learning disability.
- Carry out audit and review of care for patients in this population group.
- Proactively support local residential and care homes with patients who have learning disabilities.
- Demonstrate how you have adapted communication materials to involve patients more in their health check, and empower patients to be proactive in maintaining a healthy lifestyle.
- Ensure staff know how to recognise signs of abuse in vulnerable adults and children and what they should do to report their concerns.
- Consider how bereaved patients’ needs are assessed, even one year after their bereavement.
Evidence collaborative work with other organisations to highlight and support vulnerable patients.
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