Arch Healthcare

• Visiting the surgery
• Opening times
• Meet the team
• Register with Arch

Read on for more information about our surgery, our history in Brighton, and what we do.

1. A GP surgery offering clinical appointments – we have a relatively small number of patients, many of whom are known to us by name. We offer longer appointment times, and a high proportion of same day appointments, in order to fit in with our patients’ needs. the surgery can be used as a “care of” address, for patients to receive mail, and also as a starting point, to register with other support services. All our surgery staff, from the reception team, through to our GPs and nurses, are highly experienced, trained, and equipped to support our patients effectively. e.g. Proactive support from the moment patients walk in the door: our reception team have extensive knowledge of services throughout the city, and support patients to access these. They also provide seasonal comforts – e.g. warm clothes in winter, sunscreen, water and hats in summer.
2. An in-reach service to Royal Sussex County hospital. The aim of our hospital in-reach team is to improve health outcomes by identifying people admitted to hospital whilst experiencing homelessness, and supporting them to stay in hospital for the duration of the required treatment, managing the time of their discharge, registering them with a GP if needed, liaising with housing services to ensure no-one is discharged onto the streets, making referrals to services like Adult Social Care, Integrated Nursing Team, Justlife and the substance misuse service who all help support people once they are discharged back to the community. Part of the service involves providing patients with “dignity packs” (pyjamas, changes of clothes, toiletries, magazines), in order to make their hospital stay bearable and comfortable, making them more likely to stick with their treatment.
3. An engagement service offering non-clinical support to patients. The Justlife Heath Engagement Team work proactively, enabling patients to obtain and maintain suitable accommodation and access health and community services. Their intensive work is vital as they support people to build their confidence, take ownership of their situation, improve their health and engage positively with the wider community
4. Community Outreach: Our dedicated outreach team exists improve access to our services, reaching people who might not otherwise engage with Arch Healthcare. The team has built up links with hostels, day centres, and street outreach services, in order to offer healthcare at those locations. this team has built up trust with key services, in order to reach people who may not have engaged in looking after their health for extensive periods of time.
5. Arch provides specialist health and clinical input in a variety of strategic areas for the city, working closely with other healthcare providers, third sector partners, the city council and NHS Sussex. We are a lead partner on a nationally important, service improvement project Common Ambition, which brings the voice of lived experience into the heart of improvements to the homeless healthcare system. Arch also offers a yearly homeless health conference for frontline workers in the city, and provides regular training for medical students, hospital staff (clinical and not), and frequent training opportunities for frontline workers across the city, skilling them up to spot common health conditions and how to support clients with these.

The need for improved homeless health services is significant: homelessness has a huge impact on the physical health of the individual. According to the Faculty for Homeless Health, people experiencing homelessness are 34 times more likely to have tuberculosis, 50 times more likely to have Hepatitis C, 12 times more likely to have epilepsy, 6 times more likely to have heart disease, and 5 times more likely to have a stroke. Recent research by Homeless Link showed that in addition to physical health issues, 86% of individuals experiencing homelessness have mental health problems, 39% take drugs or are recovering from a drug problem and 27% have, or are recovering from, an alcohol problem.

Homelessness can create a level of complexity that results in people accessing acute healthcare services disproportionately (due to a combination of physical and mental ill-health, drug/alcohol misuse and a lack of secure accommodation). People experiencing homelessness attend A&E six times more often, are admitted to hospital four times more often and stay in hospital three times longer than non-homeless people (Faculty for Homeless Health). The combination of extremes of poor health and difficulty engaging in healthcare services has deadly results: The average age of death for a man experiencing homelessness in the UK is 45 and for a woman it is 43 (ONS 2018). These national statistics are reflected in the current figures for Brighton & Hove where last year 36 people died while homeless (2019 Arch patient data) – these deaths were largely preventable.

However, even where excellent services exist, the needs of people experiencing homelessness are not well met (Advisory Council on the Misuse of Drugs, 2019). This is because the time needed to address their health issues (the severity of need can make for slow progress) means that they can get ‘lost’ in the system, or at the transition points between services. This is true in Brighton and Hove, despite the steps taken to improve homeless healthcare. Arch clinicians and Justlife support workers report feedback that whilst individual services are of a very high standard, the overall local health service is complex, disjointed, inflexible, inadequate for the needs presented and ultimately very difficult to navigate. Arch patients often offer insights on how this can be improved. More formally accessing the voice and experience of those with lived experience of homelessness will enable us to work collectively to improving the health systems available, including transition points between services. We know this can work – co-production of mental health services with patients has been shown to improve health services (NHS Improvements).

In all of our work, we are driven by our Vision and Values. These drive us to provide the best possible service to our patients, and to continue to improve our practice.

Arch is part of the East and Central Brighton Primary Care Network (PCN). This is a collaboration between 8 local GP surgeries, to share expertise and resources, and to develop new services, according to the needs of the neighbourhood.

Our PCN is part of the larger Brighton and Hove Federation. This organisation brings together PCNs and builds on their collaborative work, looking at the bigger picture and developing new models of care for the city.

As a new start up, the Arch board chose the model of Community Interest Company (CIC) as the best vehicle to deliver the kind of care required. According to the CIC Regulator website “A Community Interest Company (CIC) is a limited company, with special additional features, created for the use of people who want to conduct a business or other activity for community benefit, and not purely for private advantage.” This model is the best best fit for Arch Healthcare because it has all the rigour of running a professional business but all its assets are ‘locked’ and cannot be used for any other purpose than to benefit of the community which the organisation exists to support. Regardless of any surplus which is made by the company no dividends are paid to the directors. Importantly as a social enterprise Arch is entitled to apply for grants from various trusts, receive direct charitable donations and raise additional cash through trading. These multiple income streams are vital in building a surgery experience beyond the limits of commissioned services.

Arch Healthcare provides NHS services on behalf of NHS England.