The closure of the Hunter Street homeless GP practice in 2023 has reignited concerns about access to essential healthcare for vulnerable populations, particularly those dealing with substance misuse disorders. An independent review by the Independent National Whistleblowing Officer (INWO) reveals alarming failures by Glasgow City Health and Social Care Partnership (HSCP) in assessing the risks and impact of their decision.

This “hastily” made decision highlights the pressing need to prioritise the health of at-risk populations when implementing significant policy shifts.

Homeless GP Practice at the Heart of the Controversy

The Hunter Street homeless GP practice played a vital role in addressing the complex healthcare needs of homeless individuals in Glasgow. Many of its patients faced chronic conditions, mental illnesses, and substance misuse disorders, requiring specialised and consistent care. At its closure, the practice had 167 registered patients and supported approximately 600 patient contacts per year, many of whom were dealing with temporary or precarious housing situations.

Despite its critical role, the HSCP announced its closure in early 2022 and finalised the practice’s shutdown by April 2023. This decision stemmed from financial pressures rather than comprehensive evidence-based considerations, according to the INWO report.

Assessment and Engagement Failures Revealed

The INWO investigation upheld a whistleblower complaint about the GP practice closure, citing multiple failures:

• Lack of Stakeholder Consultation: The HSCP failed to execute a meaningful process of engagement with key stakeholders, including staff, local GP practices, and third-sector organisations. According to the review, these groups expressed “shock and concern” when the abrupt closure announcement was made.
• Ineffective Impact Assessment: Risk assessments and equalities impact assessments (EQIA) were conducted only after the decision to close the practice had been made. The INWO highlighted that this approach violated both national and HSCP guidelines, reflecting a disregard for the systematic evaluation of long-term risks.
• Neglect of Vulnerable Patients: Insights from experts emphasised that local GP practices might not have the capacity to handle the complex healthcare needs of homeless patients. Without adequate preparation, these patients risk slipping through the cracks of the healthcare system.

Impacts on Substance Misuse Disorder Patients

For individuals struggling with substance misuse disorders, consistency in healthcare provision can mean the difference between recovery and relapse. Specialised homeless GP practices such as Hunter Street provided focused care for patients navigating physical health challenges, addiction recovery, and mental health struggles.

The practice’s abrupt closure forced local GP surgeries to take on these patients, leaving many unprepared to meet their unique and intensive care needs. According to experts referenced in the INWO report, homeless individuals with substance misuse disorders often require more frequent and diverse interventions, from harm prevention strategies to managing co-existing mental illnesses. Relocating care without thorough planning jeopardises their continuity of treatment.

Examining the Broader Consequences for Healthcare

The closure of the Hunter Street homeless GP practice also highlights wider concerns about how policymakers make healthcare decisions in financially constrained environments. The INWO report indicated that financial pressures, rather than robust stakeholder feedback, drove the HSCP’s decision-making process.

This reliance on short-term cost-saving strategies can have long-term ramifications, particularly for services supporting underserved populations. Local GP surgeries, already under strain from staffing shortages and rising caseloads, might lack the resources or expertise to provide equal quality care for former patients of Hunter Street. This creates ripple effects, not only worsening outcomes for those directly affected but also burdening broader NHS services such as emergency departments.

Hunter Street Closure: Prioritising Vulnerable Patients

The findings from the INWO highlight the mistakes that led to the closure of the Hunter Street homeless GP practice. Now, the HSCP must address these failings while committing to the recommendations outlined in the report. A spokesperson for the organisation reaffirmed their commitment to continuous improvement, acknowledging the growing pressures of rising demand and financial constraints.

Looking ahead, it is vital for healthcare policymakers to prioritise meaningful engagement, thorough risk assessments, and strategies rooted in equity. Vulnerable groups, particularly those struggling with substance misuse, depend on specialised healthcare services that truly understand and respond to their unique needs. Neglecting these considerations risks further marginalising some of the most vulnerable members of society, perpetuating cycles of poor health and instability.

By learning from past mistakes and focusing on thoughtful, patient-centred reforms, organisations like the HSCP can better support those most at risk. This situation serves as a stark reminder of the importance of prioritising health outcomes, even in the face of financial pressures.

The closure of the Hunter Street practice underscores the urgent need for comprehensive risk and impact assessments when making decisions about critical healthcare services. For individuals with substance misuse disorders, access to consistent, specialised care is not just beneficial—it is absolutely essential.

Source: dbrecoveryresources