1. Our journey 2003 - 2013 Past achievements, new challenges Dr. Les Goldman - Medical Director

2. Aim Review and celebrate achievements over the past 10 years Look forward to new projects and challenges

3. Growth 2003: Bevan House opens - no registered patients Sept 2011: 1,500 Oct 2013: 2,286 (52% increase in 2 years) Growing team – Admin – Clinical Extra services

4. Reaching those in need Young patients, male predominance Homelessness 33% Seeking asylum 47% Patterns of morbidity – Tri-morbidity – PTSD – Hepatitis, HIV Patterns of mortality

5. Understanding health need - morbidity HIV analysis 2013 30 HIV + patients 27 Africa 2 East Europe 1 China 8 men 22 women 20 on antiviral treatment National prevalence 0.15% Practice prevalence 1.4% African patients 7% African women patients 12.2% Learning point – Need for screening in highest risk groups

6. Understanding health need - mortality Deaths analysis 2010-12 – Average age 41 (range 19 to 62) – 56% alcohol problems – 56% other drug use – 45% homeless or temporary accommodation – 39% mental health problems – Last seen at practice 0-20mths before (average 5 months) Learning points – Vulnerability to violence – Loss of opiate tolerance on prison discharge – Difficulties of encouraging compliance with treatment

7. Quality of care A&E usage – A&E attendance rate in patients registered for > 12 months half that of newly registered patients Specific quality targets – Annual health checks for those at risk – BBV screening Education for clinicians CQC – “All the patients were keen to praise the practice and were very enthusiastic about how valued the service was” – “This practice provided a much needed, incredibly valuable service”

8. Team work and partnerships Team commitment and values – Health Hope Humanity Direct partnership working – Working Women’s Project for TLC clinic – Other new services Wider networking – Asylum organisations, street homeless services

9. Social Enterprise in Primary Care Social Enterprise status Sept 2011 through NHS Right to Request programme Independence, freedom to innovate Flexible, alert and responsive New opportunities to attract funding New skills – Board, wider SE network Responsibility to community Profit reinvested for community benefit

10. New developments in the pipeline Responsive to need, alert to opportunities Dreams become reality?

11. An integrated system of homeless care - a 1st for Bradford Expected outcomes More appropriate care Improved health, housing and general wellbeing Reduced costs – Shorter hospital stays – Reduced admissions – Reduced A&E usage Partnership between health, housing and social care Hospital In-reach Team Intermediate Care Service Outreach Street Medicine Team Primary Care Centre

12. Hospital In-Reach Team Bradford Bevan Pathway Specialist GP, Nurse & Housing Support Worker Multidisciplinary patient-centred approach to improve care and discharge planning for homeless in-patients Work with A&E, other vulnerable groups 2 years funding from NHS Excellence Innovation & Strategic Development Fund

13. Intermediate Care Service BRICS 14 wheelchair accessible units opening Winter 2013 On site health, housing and support services “Step-down” facility for homeless inpatients no longer needing acute hospital care Possible “step-up” facility to avoid admission Capital funding, revenue costs to March 2014 from NHS Homeless Hospital Discharge Fund

14. Street Outreach Street Medicine Team GP, Nurse and Mental Health Worker “meet people in their own reality” Flexible sessions – Homeless drop-ins – Street work – Mobile clinic – Support for workers Funding by CCGs until March 2015

15. New premises plans Grant and loan from Social Enterprise Investment Fund to purchase and refurbish large Grade 2 Listed city centre premises Room to expand services and innovate Space for partner agencies Rental income reinvested for community benefit

16. A lot to be proud about

18. Aneurin Bevan 1897-1960 “We should take pride in the fact that despite our financial and economic uncertainties, we are still able to do the most civilised thing in the world, put the welfare of the sick in front of every other consideration” Feb 1948