GPs ‘struggling to treat homeless people’, study finds

General practitioners in England are struggling to treat people experiencing homelessness, a groundbreaking new study has found.

The research, from King’s College London and the University of Surrey, found single people experiencing homelessness in England were able to access their local doctor 5.8 times over a year on average compared to 18.6 times for specialist health centres.

Participants who attended regular GP surgeries were less satisfied with the service they received: 56% said they definitely had confidence and trust in their doctor or nurse when last seen. That was far lower than the proportion who said the same among those who attended specialist GPs (81%) or specialist health centres (82%). 

Dr Maureen Crane, the report’s author, said GPs needed more support to help people experiencing homelessness, who often have greater health needs than and a lower life expectancy than the rest of the population.

“Regular GPs are the main primary health care provider for many people who are homeless, particularly outside large cities,” said Crane, visiting senior research fellow at the NIHR Health and Social Care Workforce Research Unit at King’s College London. “It is, therefore, essential that they have the resources to support patients who are homeless, many of whom have multiple and complex health needs and find it hard to engage with services.

“The benefits of introducing a ‘homelessness lead’ into these GP practices to coordinate care for patients who are homeless should also be considered.” 

The study is the first in the UK to compare different models of primary healthcare provision for people experiencing homelessness.

It found participants were less likely to receive adequate care for substance misuse issues with just 15% of the 363 people tracked in the study receiving continuity of care for drug issues. By contrast, 85% of participants in the study were able to access adequate support at specialist health centre while 56% were able to get support at specialist GP practice.

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The relatively poor performance of regular GP practices for some outcomes “raises questions” about their role in providing health care to patients who are homeless, and when these practices might require additional support, the researchers said. 

Specialist health centres and specialist GP sites were found to be the most effective overall. Flexible drop-in clinics and longer-than-usual GP appointments, and close relationships with mental health, alcohol and drug services as well as hostels, day centres and street outreach teams all benefited patients, the report said.

But staff at regular GP practices reported insufficient resources prevented them from working in more proactive ways with patients who were homeless, with those attending these practices also reporting longer waiting times. 

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And all of the models of care studied reported insufficient mental health services in their area despite 91% of the people who participated in the study reporting mental health issues. There was a similar unmet need for dental treatment.

Professor Kathy Rowan, director of the NIHR Health and Social Care Delivery Research Programme, which funded the study, said:  “Homeless people are among the most under-served and most vulnerable in our communities and often have very complex health needs. This is an important study and the first to compare, comprehensively, the impact of different models of primary care provision for homeless people. 

“This study has the potential to inform improvements in the organisation and delivery of primary care services in order to meet the complex needs of homeless people, going forwards.” 

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