Ensuring primary care reaches the ‘hard to reach’

The provision of primary care services to homeless people, travellers, sex workers, victims of domestic violence, asylum seekers and refugees is a recognised problem in the UK. It is of national importance to explore new and innovative approaches to improve this situation. Following the creation of a new primary care service for ‘hard-to-reach’ groups in Norwich, a consultative approach to its evaluation was initiated. Methods were review of local and central policy documents, semi-structured interviews with local health service managers for context, interviews with agency workers in close contact with the client groups, and questionnaires to access the views of the healthcare professionals providing front-line clinical services. Five evaluation criteria emerged that embraced all views. These address access to healthcare for the target groups; service responsiveness to the healthcare needs of the client groups; the efforts of the service to overcome any existing barriers; effective involvement of service users and their representatives, and promotion of multi-agency co-operation; and successful (re-)integration of patients into mainstream general practice. These criteria will be employed in the ongoing evaluation of the service.