WIDER POLICIES
English Health Policy

Key Policies: 

The NHS Plan: A plan for investment, a plan for reform states that socially excluded groups, including homeless people, require targeted intervention to reduce health inequalities.  Three of the main policies affecting the way that health services are delivered on the frontline which may help to achieve this are:

• Personal Medical Services (PMS).
• The National Enhanced Service for Homeless People (NES).
• Alternative Provider Medical Services (APMS).

Personal Medical Services (PMS)

The Personal Medical Service is a locally agreed contract between GPs and their local Primary Care Trust (PCT) to provide a service to a particular group of people in their area.  The agreement is based on the levels of resource appropriate to the work they do and the services delivered rather than based on the number of patients on their list.  In 2003, around two-fifths of GPs were in some sort of a PMS contract.  It is not known how many of those provide a service for homeless people.

PMS contracts are the main vehicle for providing healthcare specifically to homeless people in England (due primarily to the fact they have been around longer than the other two initiatives discussed below).  They potentially allow a GP to devote time specifically to homeless people (and so presumably to develop more of an understanding about homelessness and health than an average GP).

One issue that arises is consistency of provision - whether or not an area has adequate services that meet the needs of homeless people will depend on whether a GP in that area has decided that health among the homeless population is an issue, and decides to arrange a contract with the PCT on that basis.  The shape of the resulting service will also depend on the approach of that GP, with the possibilities ranging from a basic service to a comprehensive service, and including outreach or requiring the patients to come to the surgery by appointment.

An associated development to PMS are Walk-in Centres, introduced in 2000, which have obvious advantages for homeless people in that they require no appointment and are open at all times.

National Enhanced Service for Homeless People (NES)

The NES is one of three types of contract available to GPs under the new General Medical Services (GMS) contract introduced in April 2004.  It is a specialised service provided according to specific guidelines drawn up to help disadvantaged groups (one of which is homeless people).  Thus it is similar to the Personal Medical Services but, unlike the PMS, the GP remains in a General Medical Services contract. 

The Department of Health has produced guidelines for the National Enhanced Service for care of the homeless.

As with the PMS, consistency of provision for homeless people is an issue.  In particular, NES contracts are permitted only where there is a ‘critical mass' of patients, and therefore homeless people in ‘non-critical mass' areas will not have the possibility of such a service.

Alternative Provider Medical Services (APMS)

The Alternative Provider Medical Service basically enables a company (e.g. Boots) or a charity (e.g. Crisis) to request money from a Primary Care Trust to employ a GP or health care professional to deliver a particular type of service.  This means that, unlike the Personal Medical Services or NES policies, both the initiative and the focus and shape of the consequent services lie with the voluntary or private sector provider.  It is hoped that this policy will revolutionise health care for the hard to reach but, clearly, this depends on how the specialist service providers react.

Page last modified on 22/06/2006 at 11:47