Do the homeless get a fair deal from general practitioners?

Area of Science:

• Public Health
• General Practice
• Health Services Research

Background:

• Homeless populations exhibit poorer health status compared to the general population.
• High prevalence of psychiatric illness, substance misuse, and socio-medical issues are common among homeless individuals.
• Specialized healthcare services, like the Bristol Primary Healthcare Project, aim to address the unique needs of homeless people.

Purpose of the Study:

• To evaluate the current practices of General Practitioners (GPs) in registering and treating homeless patients.
• To identify barriers and challenges faced by GPs in providing healthcare to the homeless population.
• To inform policy regarding support and incentives for GPs serving homeless individuals.

Main Methods:

• A postal questionnaire survey was distributed to 155 general practices in the Avon FHSA area.
• Practices included fundholding and non-fundholding, across inner city, urban, and rural locations.
• A response rate of 75% was achieved, with 117 completed questionnaires returned.

Main Results:

• Only 27% of practices would fully register a homeless person; 4% of fundholding practices would do so.
• Inner city practices were more likely to fully register homeless patients (55%) compared to fundholding practices (4%).
• GPs perceived homeless patients as more difficult to treat (79%) due to social problems (90%), lack of medical records (88%), complex health issues (79%), and substance misuse (78%).

Conclusions:

• A significant reluctance exists among some general practices to fully register homeless patients, particularly fundholding practices.
• Barriers include social issues, lack of medical history, complex health conditions, and substance misuse.
• Government incentives are needed for GPs to register homeless individuals without compromising contract targets, alongside enhanced health education and promotion initiatives.