Published: 06 October 2023
A study comparing different models of primary health care provision for homeless people, has found regular GP services struggle to provide levels of care seen at specialist health services.
Experts at King’s College London and the University of Surrey led the NIHR-funded HEARTH study. It is the largest of its kind in the UK and involved 363 single homeless people in England. The results are published in the journal Health and Social Care Delivery Research.
Researchers compared four models of primary care services across 10 sites:
- Specialist health centres for people who are homeless
- Mobile homeless health teams
- Specialist GP services (regular GP practices with specific services for homeless people)
- Regular GP practices (with no specialist services for homeless people)
Participants using regular GP practices saw their GP 5.8 times on average during the 12 month study. This compared to 18.6 times among those attending specialist health centres. There were no statistically significant physical or mental health differences between the study groups.
Regular GP practices were less likely to provide continuity of care for substance misuse problems. 15% of participants received this help. This compared to 85% at specialist health centres, and 56% at specialist GP practices.
Participants at regular GP practices were less satisfied with the service they received. 56% said they definitely had confidence and trust in their doctor or nurse when last seen. This was lower than among those attending specialist GPs (81%) and specialist health centres (82%).
Staff at regular GP practices, reported insufficient resources prevented them from working in more proactive ways with homeless people.
Regular GP practices scored relatively high for health screening. This was almost as high as specialist health centres. Two sites had successfully developed a health screening template for homeless patients.
Specialist health centres and specialist GP sites were found to be the most effective of the four models. They provided flexible drop-in clinics and longer-than-usual GP appointments. They worked closely with mental health, alcohol and drug services. And also with hostels, day centres and street outreach teams. These are factors likely to have contributed to their success.
91% of all study participants reported they had mental health problems. Staff across all four models of care reported insufficient mental health services in their area. This affected the help they could provide to patients.
82% of study participants described needing dental treatment. But these needs were often unaddressed. This was despite dental services for homeless or vulnerable people being available at, or near 7 study sites.
Dr Maureen Crane, Visiting Senior Research Fellow at the NIHR Health and Social Care Workforce Research Unit at King’s College London, said: “Regular GPs are the main primary health care provider for many people who are homeless, particularly outside large cities. 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.”
Professor Kathy Rowan, Director of the NIHR Health and Social Care Delivery Research (HSDR) 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.”