Primary health care services for single homeless people: defects and opportunities

An innovative residential centre in west London during 1997-1998 helped older rough sleepers leave the streets and resettle in conventional homes. Many clients presented with multiple physical illnesses complicated by chronicity and poor management. The centre initially experienced difficulties in obtaining health care for the residents, briefly relied on an A&E department for treatment of serious and minor ailments, and latterly was served by a GP practice supported by special funding.

The aims of this study were to describe the problems of providing at short notice primary health care services to a high-need group, and the prospective opportunities for the delivery of the required care.

A monitoring study collected routine operational data, life histories from 88 residents using a semi-structured questionnaire and information from 61 residents about their contacts with GPs before residence in the centre. Interviews were also conducted with the centre's staff, a Health Authority officer and a GP who treated the residents.

The medical care of the residents was a major concern. Many had physical illnesses yet three-fifths had not seen a GP for more than 5 years. Many were not registered, even among those who recently had become homeless. It was difficult to organize the residents' medical care and to access special funding at short notice. When funding was secured, there were difficulties in contracting the service.

Current registration and commissioning procedures are ill fitted to provide primary care services to a high-needs group at short notice. Primary Care Groups, special funding and contractual arrangements provide opportunities for GPs and primary health care workers to provide an improved service to marginalized and special needs groups. The responsibility to identify and respond to exceptional needs should be clearly defined and allocated.