Inside Hackney's Greenhouse GP surgery where the homeless get check-ups for their pets - and sleep
PUBLISHED: 18:19 29 September 2017 | UPDATED: 20:53 01 October 2017
The Greenhouse, off Mare Street, is a GP surgery specifically for homeless people. Emma Bartholomew met some of the patients who go there for treatment, advice and even sleep
“What I like about here is it’s like a sanctuary,” Marlon Bassial tells the Gazette, as we sat in the Greenhouse surgery waiting room.
“When you roam the streets – or walk like a zombie, because that’s basically what we are – and everyone is looking at you, thinking ‘you got yourself in a mess’ without even knowing you, this is a sanctuary.”
Marlon found himself homeless just over a year ago when he lost his job as a waiter and bar tender, and was told he couldn’t claim jobseekers’ allowance or housing benefit.
Too scared to sleep on the streets in case he gets stabbed by people out to steal his precious laptop – through which he hopes to soon secure another job – the only sleep he gets nowadays is usually upright, here on the bright pink and orange plastic chairs in the surgery, before it shuts at 6pm.
The 49-year-old Dutch national, who blames Brexit for the mess he is in today, can also shower here. He hopes that keeping himself looking immaculate will help his job prospects. He’s got an offer for something to start Saturday, but doesn’t have the bus fare to get to central London.
He can’t walk there either because of his swollen legs – something medics at the Greenhouse help out with.
“The human body needs to rest and if you walk the whole day on your feet and you don’t sleep you see what happens – it fills with liquid,” he said. “I have one friend who sometimes lets me stay Friday with him, and as soon as I have one night’s sleep it goes. The GP sent me to hospital and he said there’s nothing we can do – you just need to find somewhere to sleep.
“To be honest as I’m getting older you need to get yourself out of this situation because it’s not funny and I consider myself still quite young. If I don’t do it quick I might end up losing my leg and I’m not in the mood for that. I don’t have kids and I don’t have a wife but I really would like to.”
The life expectancy of a homeless person is estimated to be 20 to 25 years less than the rest of the population, and they are more likely to suffer from chronic conditions. According to the charity Homeless Link, 41pc of homeless people suffer from a long-term physical health problem compared with just 28pc of the general population. They are more likely to suffer from diabetes, strokes, heart disease and high blood pressure as well as alcoholism and substance misuse.
AT Medics, which runs the Greenhouse, has been tackling these issues head on, and the practice was labelled “inspirational” by health inspectors. Four out of the 16 GP practices based in London rated outstanding by the Care Quality Commission are managed by the firm, which says it tries to deal with problems before they get too serious.
Lead GP Dr Muneeb Choudhry told the Gazette: “There is dampness and it rains in London. If people are living on the streets the floor is likely to be full of moisture or sweat, and they are more likely to get diabetic complications like ulcers that can go septic or foot infections. For homeless patients it’s key – they can die from that.
“They are more likely to smoke, so we try to reduce their smoking rates – it’s hard for them because it’s a comfort thing, but if you increase social interaction with the surgery and nurse it increases their chances of quitting.”
The surgery also offers checks for patients to see if they have lung disease – which they are often unaware of – to ensure early treatment.
Marlon thinks staff at the surgery should be recognised with an award for their work.
“You get different characters here,” he said. “Some people are OK and you can tell them: ‘I can’t help you right now.’ But some people will explode – they start screaming and yelling. The abuse is ridiculous.”
AT Medics focuses on breaking down barriers with the homeless to make sure they walk through the Greenhouse door in the first place – and looks for innovative ways to entice them in, like free pet health checks.
Once there, rather than the standard 10 minute GP appointment, they give 15-minute slots because each patient is “quite high in demand”.
“When they do come in you want to make the most of the opportunity of seeing them and capture everything from them,” says lead GP Dr Muneeb Choudhry.
To try and decrease the rate of patients who don’t turn up, they struck a deal with Pret, which provides food boxes – and once word got out more patients started coming for their appointments.
When AT Medics took over running the surgery from East London Foundation Trust in April last year, they retained the staff already there.
“They were one of our assets,” said Dr Choudhry. “They have a good relationship with the patients and banter with them, and that helps release a lot of the frustrations these vulnerable patients have. They are more prone to becoming upset and frustrated about something, and it gives them more of a chance to defuse the frustrations in a way.
“Once we get the barriers out of the way they are more likely to turn up when they are feeling ill.”
They also introduced flexibility for patients who might turn up late or for those who just want to walk in.
Sharing the building with a charity that gives advice on housing can also act as a draw – as can the post boxes that allow patients to use the surgery’s address to receive letters.
But the pet health checks were a breakthrough.
“A big thing about homeless patients is their pets,” said Dr Choudhry.
“For most of them companionship may be found through their pet dog. It’s an important part of their day to day and getting through life, where they have some sort of responsibility.
“We did a pet health check day, and they really liked that, because they recognised that we recognise what was important to them, and it was increased footfall to the surgery. We could do health checks on the patients while they were waiting for their dog to have their health check too.”