GPs often send letters to housing organisations, including local authorities, to raise an issue relating to their patients’ medical conditions and prompt action to be taken. GPs dislike writing them because they take time and they are not convinced they work. Patients are charged for them. Housing organisations often have different mechanisms in place to address medical needs and unsuitable living circumstances. Increasingly, they are looking for better ways of responding to individuals whose health is compromised by poor house conditions.
With a few simple changes in practice, GPs could end the practice of writing such letters and secure appropriate action for those patients whose health they really believe is being compromised by unsuitable housing.
Two types of housing letter
There are two reasons that GPs write letters to housing organisations:
1. To facilitate housing or rehousing: to increase a patient’s chance of being offered a council or housing association property or to speed up a move to a different, more suitable, property
2. To compel landlords to make improvements to a property: to persuade a patient’s landlord to take action in order to improve their home, where it is in a poor state of repair and prejudicial to their patient’s health
Most housing organisations no longer require letters from GPs about their patients’ health to substantiate an application for housing or rehousing. Increasingly, they employ self-assessment protocols through which individuals declare their own medical conditions and have systems in place to make good judgments about housing priority based on medical need. As patients get access to their medical records and social prescribing increasingly involves housing, the need for medical opinion from a GP will diminish further.
However, GPs may have particular concerns about individual patients, for example, if they seem unable to make their case for rehousing themselves or if they are particularly vulnerable. In these instances, and with the consent of the patient, GPs should contact the relevant person in the local authority, ALMO or housing association. They should do so by telephone and email.
Four measures General Practice should adopt are:
1. Provide access to patient records and advise patients how to present their case for housing
Medical evidence helps housing organisations to make better decisions about priority for housing and rehousing. The better quality the information provided, then better judgements can be made. Sometimes applicants provide photocopies of their medical records. GPs can advise their patients how to present their medical case themselves.
2. Include housing advice in social prescribing
Some housing organisations are becoming involved in social prescribing. They have staff working from GP surgeries and alongside patients, securing non-medical solutions to some of the issues they present. Where this is happening, patients housing needs are attended to via social prescribing.
If you have, or are setting up, a social prescribing service you should ensure that patients’ can receive housing advice and find housing solutions through the service.
3. Set up new arrangements with Housing Options, Lettings or Allocations teams
The rules and processes relating to who gets access to council and housing association homes are complicated and they operate differently in different localities. It is not necessary for individual GPs to understand the system.
If you don’t do social prescribing or your social prescribing team does not include housing advice, then a strategic lead operating on behalf of a group of Practices should identify the person who has responsibility for Housing Options, Lettings or Allocations in the locality (there is often a single point of access and a common system for people seeking a council or housing association home, usually based within the Council). They should liaise with this person to set up new local arrangements for addressing the rehousing needs of vulnerable patients who find it difficult to make a case themselves. These new arrangements should be communicated across the Practices and other primary care professionals.
The new arrangements should include telephone and email communications rather than letters because two-way communication works much better than a letter, which often prompts more questions from housing organisations. A quick phone call to discuss the matter, followed by an email where written evidence is required, is the best way of making sure that the information provided is relevant and will be acted upon.
4. Refer vulnerable patients whose medical needs may be helped through rehousing
GPs and primary care professionals should identify those patients with particular medical conditions that they believe may be partly resolved or improved through housing or rehousing. With the patient’s consent, they should refer them to the relevant person via the agreed arrangements (see 3 above).
Local authorities have a legal duty to take reasonable steps to investigate complaints relating to ‘any premises in such a state as to be prejudicial to health or a nuisance’ (Environmental Protection Act 1990). In practice, this means undertaking a Housing Health and Safety Rating System assessment. They also have powers to intervene and safeguard the health, safety and wellbeing of the occupier where a significant risk to the tenants’ health is discovered.
Some councils are going beyond this and have established ‘healthy homes’ programmes. In some instances councils, ALMOs and housing associations actively assist tenants who may be vulnerable to eviction by the landlord due to making a complaint, sometimes offering rehousing as a solution.
GPs and primary care professionals are in the unique position of being able to identify when a poor quality rented home is impacting on a patients’ health. They can support these individuals to make a complaint to the Council, which will be the first step towards resolving their housing problem resolved.
If you don’t do social prescribing or your social prescribing team does not include housing advice, then a strategic lead operating on behalf of a group of Practices should identify the senior officer in the Council’s Environmental Health Team. They should establish the circumstances in which the local authority will investigate a complaint and agree arrangements for receiving complaints from patients whose rented homes they believe are impacting negatively on their health.
This information should be shared with GPs and primary care professionals who can then either:
- advise patients/tenants on how to raise a complaint with the Council and provide substantiating evidence in the form requested.
- identify those patients with particular medical conditions that they believe are being exacerbate by living in a poor quality rented home. With the patient’s consent, they should refer them via the agreed arrangements. Typically, this should be by telephone and email, rather than by letter.