Severe Multiple Disadvantage (SMD) refers to those in the community who experience two or more inequalities/disadvantages in their life that will effect their mental and physical health, as well as meaning that they may struggle to recieve the right support to improve their living standard. 

These inequalties could include:

• Ill mental health
• Drug and alcohol addictions
• Homelessness / vulnerable housing
• Contact with criminal justice system (historically/present)
• Domestic violence/sexual abuse victims

Nottingham city has the 8^th highest prevalence of severe multiple disadvantage amongst the community in the UK, and this issue led to the creation of the Changing Futures programme through Nottingham city partnerships. 

As part of the Changing Futures programme, Parliament Street Medical Centre has an embedded Severe Multiple Disadvantage (SMD) Practitioner within the practice to identify those at risk, and further support those patients that may struggle to access the services and correct healthcare advice that they need. This role is funded through the Changing Futures Programme and is helping to develop Parliament Street Medical Centre as a Centre of Excellence for supporting SMD patients (those that experience multiple health and social issues).

The support that the Changing Futures SMD Practitioner offers include:

• Practice registration support – helping patients to go through the health forms and processes needed to register at Parliament Street Medical Centre
• Regular health screen opportunities
• Extra time for appointments where necessary
• Supporting the patient with specialise referrals
• Opportunities for specialist clinics (within the practice on Upper Parliament Street, or other communities)