This is a 15 month pilot project, from July 2019, initially working across 3 GP practices (Gurney Surgery, Oak Street Medical Practice and Prospect Medical Practice) and in partnership with St. Martins.

St. Martins support to:

• Maximise independent living and prevent homelessness in our community by offering a hand up – housing, support and care – to the most vulnerable
• Enhance understanding and compassion towards homeless people in our community through education and advocacy
• Work with other voluntary organisations, housing associations, community and church groups to raise awareness of homelessness as one of the principal contributors to social exclusion.

The pilot is looking to provide an efficient and helpful service to the involved practices, patients and staff. The service will provide a robust, safe and effective pathway, within primary care, to engage and support patients with severe and multiple disadvantages (Severe and multiple disadvantage can be considered to be one or more of the following: Offending, Substance misuse, Homelessness). The pilot will use a multi-disciplinary approach involving: GP, Healthcare Assistant, Support Worker, Clinical Pharmacist and Administration.

The practice will contact you, via either telephone or letter, if you have been identified as being suitable for this service and the practice will then refer you to St. Martins. The multi-disciplinary team will then establish an initial plan for engaging and supporting you. At this point, you will also receive an information leaflet about the service and this will include details of who to contact if you have any queries or concerns.

As part of the referral made by your GP details of your basic demographics such as your name, contact details and NHS Number, a summary of your health conditions and an overview of your immediate support needs will be shared with St. Martins. St Martins will then establish contact with you to discuss treatment and support options.  Subject to your agreement, your information will then be shared with other health and social care providers, community and/or voluntary sector organisation so that they can identify a suitable package of care for you. We will only share the minimum information necessary to inform your care.