Free healthcare for those that need it. Just as it should be.

By Dr Nicola Roberts

I started working at Riverside Medical Practice (RMP) during my GP training in 2018 and that’s where my interest in homeless health began. We arranged a walking tour of Shrewsbury with a difference for a group of eight trainee GPs: we visited MIND, Shrewsbury Food Bank, the library, Shropshire Recovery Partnership and The Shrewsbury Ark.

I’d always been intrigued by the Ark: I’d often walked past and it was the time when you couldn’t see in the windows and so the chance to look round was one not to be missed!

Rose showed us around and answered our questions, but I was distracted by a poster on the wall. It was advertising flu jabs at a local pharmacy for £9. I was horrified: if I was on the streets, needing money for food then I know I wouldn’t be spending £9 on a flu jab!

Later that month I attended the annual conference by the Royal College of General Practice. There was a lecture about vulnerable patients and how primary care can support them more.

One of the speakers was a GP that specialised in inclusion health (health care for excluded groups such as the homeless, refugees, women in prostitution, travellers and asylum seekers), I’d not realised that GPs specialised in this area so I excitedly went to speak to her.

Following her advice, I approached our CCG (local NHS funding group) for funding and started a homeless health fellowship in my final year of GP training. I completed several training courses and went to Leeds, Bradford and Oxford to see what established homeless healthcare looked like -and how it really worked.

This led to applying for further funding to start an outreach clinic at the Ark itself.

On one of my tours of the Ark I had been shown a store cupboard, and I wondered if we could turn it into a consultation room.

Dr Sarah Henshaw (one of the partners from RMP) and I went to have another look with a measuring tape… my goodness it was small. I googled sizes of examination couches and there were some that could fit. We looked around at the storeroom with floorboards thick with dust and a grill over the window (complete with a statue of Jesus looking out of it): it didn’t feel very clinical at this point!

Thankfully, Wendy had more vision and asked what we needed. I had a long list already -flooring we could mop, a blind for the window, a sink (there was no plumbing at all), a desk, shelves…. I went on. She wasn’t phased and the plan started to form!

We were due to start a weekly clinic with myself or Dr Henshaw with Sister Kerry Brown. But then the floods in February 2020 delayed things: both the Ark and Riverside were under water and then we were into lockdown. We kept in contact and supported our patients remotely.

Once lockdown started to ease, I started doing the outreach clinics. I tried to do these over the phone to start with, with limited success as they often didn’t have a phone or didn’t answer it! I quickly realised I needed to see them in person and so the following week I started at the Ark properly.

By September I’d done 12 weeks of clinics at the Ark in our small (but beautiful) room. I was busier every week and was seeing people that hadn’t seen a doctor for years.

I was able to start treatments for physical and mental health, as well as link up with other services such as SRP and housing. We were building up our expertise at RMP as well: with regular advice from Dylan Roberts (mental health advanced nurse practitioner) and Dr Sam O’Connor joined the team in September so that the outreach clinics can run every week.

The clinic is definitely my favourite day of the week: they are often chaos with no real timings, but I’m able to listen and advocate for the patients, which is really humbling.

The difference you can see when you listen, treat them respectfully and then do your best to help is so rewarding. This week one lady was telling me about getting accommodation; sharing in these moments is just fantastic.

We held our first flu clinic at the Ark in the Autumn. This week we are offering COVID vaccines to all our most vulnerable patients. No more £9 charges: free healthcare for those that need it. Just as it should be.