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Improving access to health care for Gypsies and Travellers, homeless people and sex workers

An evidence-based commissioning guide for Clinical Commissioning Groups and Health & Wellbeing Boards

The Royal College of General Practitioners’ (RCGP) Clinical Innovation and Research Centre (CIRC) has undertaken the production of this Social Inclusion Commissioning Toolkit for the commissioners from Clinical Commissioning Groups (CCGs), Public Health England, Local Authorities (LAs) and NHS England (formerly NHSCB). It is aimed at widening access to health services and contributing to improving the health outcomes of marginalised groups, by looking specifically at homeless people, Gypsies and Travellers, and sex workers, given their particularly poor health outcomes. This decision reflects the priority groups identified by the national Inclusion Health Board, and is in line with the government priority of proportional universalism and ‘improving the health of the poorest fastest’, as recommended in the Marmot Report Fair Society, Healthy Lives (2010).

This guidance is part of the Department of Health’s Inclusion Health programme of work, and it links with the Inclusion Health working groups on Data and Research; Leadership and Workforce; Provision, Prevention, Promotion, and Assurance and Accountability. It has been written primarily for the English context, but many of the issues and recommendations will be equally relevant to systems in the devolved nations. With local CCGs and Health and Wellbeing Boards (HWBs) taking on their statutory responsibilities from April 2013, this provides a unique opportunity to embed the reduction of health inequalities amongst these groups in local commissioning strategies.

This practical guide is designed to support CCGs, LAs and HWBs to commission health services in ways that improve health outcomes for the most vulnerable groups. Whilst local authorities will lead commissioning on the public health side, CCGs will take responsibility for leading the commissioning of specialist and enhanced general health services for these patients.

This guide aims to provide professionals with the following:
• an overview of the health needs of these three vulnerable groups in society
• practical support to help commissioners to build the understanding of local needs into the Joint Strategic Needs Assessment (JSNA) and Health and Wellbeing Strategies (HWBS)
• sample models of how services can meet needs to inform commisosining and local service provision, looking at both health-only and more holistic initiatives