HEALTH MATTERS 19 health service


lane) and two drop-in centres (merchants Quay Ireland and the Capuchin Food Hall). Ideally, homeless people should be treated by mainstream services. However, Irish research has replicated international research in that they do not actually make use of the mainstream primary care services and tend to go to hospital services instead. Research has regularly found rates of medical card uptake only between 55 per cent and 60 per cent, and even for those who do have a medical card many do not use their GP because of inaccessibility due to factors such as distance and appointment systems. Specialised clinics go to where the homeless person frequents. They exist all over Europe, including the UK, the US and Australia. Even in the UK, where primary health care is free to all, specialised services exist in all areas with large populations of homeless people. • In 2006, along with Frank mills of the HSE, the practice founded Safetynet, which is an organisation that networks all specialised services providing services to homeless people in Dublin and Cork. In 2009, Safetynet services provided over 14,000 consultations in dublin alone. Safetynet computerised all the various services so that they shared a common patient database. This allowed surgeries to work together in providing seamless care and to offer preventative services such as hepatitis B, flu and swine flu vaccination programmes. This service continues to be greatly supported by the Social Inclusion section of the HSE, and in particular Concepta de Brun. • our surgery, along with dr kieran Harkin, set up a specialised methadone treatment centre in two of the hostels for homeless people, which offers methadone treatment to over 30 homeless people at a time. We have reviewed patients who attended this service and found that the majority eventually controlled their drug usage and ended up in stable accommodation.


• In 2010, our surgery was instrumental in developing with Safetynet, Dublin Simon, Chrysalis, and the Order of Malta, a mobile outreach clinic which is delivered twice a week, one night working with


street-working women and one night with homeless people. It is staffed by GP trainees, Order of Malta staff and outreach workers and supervised by experienced GPs. This is an exciting new initiative that has already been very successful. • Since 1997, the surgery has provided methadone treatment to patients from the community and in 2010 has over 50 patients on treatment. The surgery has conducted customer satisfaction appraisals of this service using questionnaires and has adjusted the service in response to the results of those surveys.


“early on the practice adopted a mission statement ‘to provide the highest possible evidence- based healthcare to our patients and to address health inequalities within our area.”


• The practice was one of the founding members of North Doc/D-Doc and, as one of the original members of the Steering Committee, I negotiated that homeless people without medical cards would still be seen by D-Doc for free. • The surgery has conducted and been involved in research into health inequalities, in particular homelessness, drug users’ perspectives on the health services and administrative blocks within the medical card system. • lastly, I have been involved in gP training since 2000. In 2010, I and Dr Ming Rawat have, in co-operation with the ICGP and HSE have set up a GP training scheme on the northside of Dublin that will focus on training GPs to work in areas of deprivation. To our knowledge, this is the first such scheme to be set up in Europe.


EARLY YEARS


The practice I took over in 1997 had been run by dr james Slein since the 1950s, in a run-down Georgian building on the corner of Western Way. Dr Slein was loved by his patients – single-handedly providing daytime and night-time care. He had also responded to the huge need within the inner city, particularly during the heroin epidemic that swept dublin in the 1980s. At the start there was only me and my


receptionist, Chrissie O Connell. It was an amazing first year, where I was exposed to the realities of the effects of poverty on the health of a community while learning to respect and admire the resilience, humour and generosity of that same community. I met families that had lost several of their children due to drug overdose or HIV/ Hepatitis C. I met young people desperate to get off drugs with nowhere to obtain treatment. I also had sing songs in my waiting room, offers of presents of stolen goods and was flooded with chocolates, cakes and bottles of whiskey. I had patients on addictive medication who became intimidating if I suggested detoxing them. I used some headed notepaper I had and wrote myself a letter admonishing my practice for prescribing too many benzodiazepines and advising we would be closed down if we did not cease prescribing these medications. I made enough copies for all the patients on these medications and explained how my hands were tied. We successfully detoxed almost all of these patients and they remained loyal to the practice. One interesting story from my early years concerned the level of theft from the surgery. I remember one woman admonishing her child for bringing toilet paper in front of me. The child burst out crying saying, “but you told me to take it.” We redecorated the surgery and I bought a lot of art – many people were adamant “it would be stolen.” Not only was the art not taken, all other theft stopped as well. It proved for me that by showing respect to the community they would return it.


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