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GP access reaches ex-offenders

Knowsley is taking a different approach to extending GPs' opening hours, explains Dr Chris Mimnagh.

GP Dr Yvonne Appiah-Poku talks to an ex-offender (Photograph: Finn Communications)
GP Dr Yvonne Appiah-Poku talks to an ex-offender (Photograph: Finn Communications)

Social issues that have a serious impact on health and wellbeing affect many people in Knowsley, Merseyside.

So when Knowsley Health & Wellbeing looked at the framework for delivering the Equitable Access to Primary Medical Care (EATPMC) programme, it was clear that simply increasing the number of GP practices would not go far enough to meet its population's needs.

A primary objective of EATPMC was to increase extended hours provision and GP capacity across the area, but we also looked at how people accessed healthcare.

Ex-offenders seen at probation office

Due to limited access to and lack of knowledge of primary health services plus poor lifestyles, ex-offenders on release from prison are part of the large proportion of people using the NHS's urgent healthcare services, writes Options medical director Dr Stephanie Gallard.


More than 90 per cent of Knowsley's ex-offenders are smokers, and their commonest health problems are cardiovascular disease, mental health problems and substance misuse.


Helping this group is something I am passionate about. Knowsley's public health team had already piloted a highly effective nurse-led health assessment scheme, so I worked to move the scheme forward and shape a new service with GP involvement.


Ex-offenders in Knowsley attend South Knowsley Probation Office (SKPO) for regular supervision, but rarely visit a GP.


As there is evidence that improved access to primary healthcare will reduce the risk of re-offending, it was important to establish an effective working relationship with Merseyside Probation Trust to deliver services to this group.


We allocated a part of the Options budget to provide a GP, two nurses and a healthcare navigator in two dedicated consultation rooms at SKPO for two sessions a week. Appointments are available on Tuesdays and Thursdays and users do not need to be registered with a GP. The team also visits ex-offenders at the sites where they do voluntary work to offer on-the-spot care.


We provide a health and wellbeing plan for ex-offenders which includes signposting to relevant services, such as checking eligibility for benefits, employment agencies and housing organisations. This ensures we offer a rounded health and social care service.


Although on release from prison many ex-offenders do not have a GP, 10 offenders are fully registered with Options and more than 130 are in regular contact with us via SKPO. We have also carried out more than 145 health checks, and early indications suggest the need for unplanned care and emergency hospital admissions is reducing.

Vulnerable groups
The majority of Knowsley's 159,000 residents were happy with their GP surgery's opening times. However, we wanted to reach certain groups of vulnerable adults who did not use GP services at all.

Reasons for this vary from lacking a permanent address, so unable to register with a practice, to lacking mobility, so unable to visit a GP on their own. Some people, particularly those marginalised in society, simply did not know how or where to find a GP.

These vulnerable, hard-to-reach groups were our big challenge and meeting it led to us taking a customised approach.

Knowsley Health & Wellbeing, of which I am medical director, is an innovative partnership between Knowsley Council's directorate of well-being services (including social care, leisure and culture) and NHS Knowsley. Through close working with partnership agencies, plus valuable insight from the council, we identified groups most at risk through lack of, or limited, access to healthcare.

As well as residential and nursing home residents, the groups were residents of homeless hostels, ex-offenders being supervised on probation and victims of domestic violence, and included people with mental health difficulties. While these adults do not always access GP services effectively, they are often high users of NHS urgent and emergency services.

We need to connect them to non-urgent services and ensure that we are acting on their health issues early on to drive down health inequalities and prevent additional complications.

We commissioned a consortium of providers: Liverpool Community Health (NHS Liverpool's community health services provider), Knowsley Integrated Provider Services (Knowsley Health & Wellbeing's health and social care provider) and Urgent Care 24, the Merseyside-based GP out-of-hours provider.

New service
The new service is called Options. We used our budget from the EATPMC initiative to recruit a full range of healthcare professionals.

The Options team consists of medical director, GPs, practice nurses, healthcare 'navigators', pharmacy technician and social worker and has full administrative back up.

Options' three-year contract has been running for more than a year and over 6,000 appointments have been used so far.

The vulnerable groups' outreach work has been hugely successful - in particular, our GP-led healthcare service for ex-offenders (see below, left).

  • Dr Mimnagh is a GP in Liverpool and Knowsley Health & Wellbeing medical director, www.knowsley.nhs.uk
Options services for vulnerable adults
CommissionersKnowsley Health & Wellbeing.
ProvidersLiverpool Community Health, Knowsley Integrated Provider Services and Urgent Care 24.
LocationGP practices in Huyton, Whiston, Halewood plus outreach healthcare.
Vulnerable adults healthcare provisionIn 24 care homes across Knowsley and at South Knowsley Probation Office, the domestic violence refuge and Onward Care Centre plus three homeless shelters.
StaffInclude 8.5 whole-time equivalent GPs, 10 practice nurses, three healthcare navigators.
ServicesExtended evening/weekend opening hours in GP-led surgeries; smear tests; child health monitoring; minor surgery; maternity medical services; child immunisations; flu vaccinations; blood-borne virus screening; hepatitis B vaccination; cardiovascular checks.

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