The icy wind outside the Height medical practice in Salford is a clear sign to practice nurse Janice Hussey that she will be sending patients – stuck with the choice of eating or keeping warm – to the local food bank.
More than half of the practice’s 4,000 registered patients are classed by GPs as “very deprived”, with high rates of alcohol and drug problems, social isolation and homelessness. Increasingly, a referral to Salford Foodbank has become more crucial to their care than anything she can offer from her clinical training.
“It’s a life-and-death situation with some patients,” says Hussey. “Some can’t take their medication without food, so they are going without that too because they cannot afford to eat. It drives me up the wall.”
She refers to a man in his 50s who has type 1 diabetes and requires insulin three times a day with carbohydrates. Since he does not necessarily eat even once a day, neither does he take his medication. She is struggling to persuade him to go to the food bank. “For many people, it’s an admission of failure,” she says.
Following a recent inspection, the Care Quality Commission rated the practice as outstanding, singling out its links with Salford Foodbank for special praise. Since 2014, the practice has sent 32 patients for food parcels. Salford Foodbank, supported by the Trussell Trust, issued more than 5,000 emergency parcels in 2017, compared with around 3,700 the previous year.
Nearby, Langworthy medical practice makes even more referrals to Salford Foodbank – 263 since 2014. Currently, around 45 of their patients are surviving on GP-referred food parcels.
In the waiting room of this former pub, a huge noticeboard displays the words “food bank” in large colourful letters along with instructions on how to obtain three days’ worth of food. The practice also encourages other patients to donate tins and packets.
The Height made links with the food bank after the assistant practice manager, Holly Walsh, spotted the desperate poverty of some of the families in the waiting room. The tipping point for her was the father who regularly turned up to the surgery emaciated and with worsening mental health problems because he could only afford to eat every three or four days – otherwise his children would go without. A food bank referral letter from one of the practice’s five GPs gave him access to food parcels, and to support services signposted by Salford Foodbank, which allowed him to find employment, housing – and to get back on track.
“We are more than a GP practice,” states Walsh. “We see ourselves as something more like a community centre. Our patients are not just numbers that walk off the street. One gentleman who uses the food bank comes in an hour early for the appointment to get his referral letter, to keep warm and chat. We encourage that.”
The practice has received CQC praise for its list of patients living in vulnerable circumstances known as the “important patient register”, which includes homeless people and those with a learning disability.
One of the practice’s GPs, Dr Priyanka Sharma, estimates that poverty is a factor in at least 60% of her consultations. “The food banks can be the start of a big change in a person’s life,” she says. “In my work I have to think creatively and look at my patients as a whole. We have to do a lot of extra work to monitor our patients, and to tap into the support of other partners like Age UK, social services and the drug and alcohol teams. It is very satisfying when you see patients turn their lives around.”
Not all patients do. Some are too proud to use the three Salford food distribution points and others simply cannot afford the bus fare to the nearest one, 25 minutes walk away from the Height.
The manager of Salford Foodbank, Mark Whittington, welcomes the fact that GPs are beginning to refer people for food parcels. They may pick up problems earlier, before they escalate. When people collect their parcels, they can also be linked up with other partner organisations, including Salford Citizens Advice, Salford Mindand the Salford Foundation, which advises on fuel costs and savings.
“It’s just unfortunate that we can’t deliver,” he says. “One man walked from Cadishead – a distance of about 10 miles. It shows the level of desperation.”