GP services provided in a community outreach setting are improving access to medical care for people experiencing homelessness (PEH), according to a study.
The study, published in the British Journal of General Practice, uncovered the reasons why PEH engage with GPs in a community setting but not a specialist or mainstream GP service.
This included the settings being seen as ‘more comfortable’ and ‘safer’ than a GP practice and more convenient as they brought services together as a ‘one stop shop’, the study found.
Homeless people also reported that they were listened to more as the outreach environment was ‘more relaxed’ and the GPs ‘had more time’, the report said.
The researchers interviewed 22 PEH in England and Scotland, as well as staff and volunteers working in three different community settings.
The study found that ‘GP outreach services better enabled PEH to access medical care, with additional benefits in supporting staff/volunteers in community settings to give better health advice,’ the report said.
It added that this was consistent across all three settings, which the authors noted was ‘interesting given the differences between the day centre and the food bank settings’.
Health needs
The study also found that health needs were considered a ‘low priority’ among participants despite many having severe health needs, with many prioritising washing clothes, collecting food and showering or cleaning themselves.
The authors noted that GP care was considered ‘good-to-have if available’ among PEH, but not a service they were seeking out.
‘The GP outreach settings were seen as convenient places to see the GP and a ‘one stop shop’ for health care, food, washing and other needs,’ the report said.
Staff interviewed in the study agreed that it was ‘very convenient’ for PEH to see a GP at the outreach settings, but also ‘cautioned that this ‘open access’ system wouldn’t work if numbers increased’.
The study authors suggested that, while mainstream GP practices will not be able to provide food and clothing as found in outreach settings, they could focus on giving their waiting room a ‘welcoming feel’ with a support/volunteer worker presence.
Safe environments
Participants in the study also noted that visiting specialist primary care centres for homeless people (SPCCHP) meant risking encountering people ‘from a ‘previous life’’, with drug dealers given as an example.
They reported feeling threatened or intimidated without support workers to mediate the space, but this was not seen as significant an issue in outreach settings.
Outreach service staff also reported that homeless people accessing a community setting do not ‘have to sit silently waiting for the GP’ and instead engaged with support workers.
The researchers said: ‘This was contrasted with mainstream GP or SPCCHP services, which were often seen as places where the waiting rooms were restrictive, stressful and heightened tensions.’
One PEH interviewed in the study commented: ‘When you go to the GP surgery, you are just sat there, you know, and there is nobody talking to you. Here it is different, you are free to talk, you know, like people to talk to while you are waiting. That’s a really good thing, it calms you down as well.’
Breaking barriers
The study also identified barriers PEH often face when trying to access primary care, including inflexibility of the health care system, negative staff attitudes and difficulties with registration, and a lack of specialist primary care centres for homeless people (SPCCHP).
It also noted that one in three deaths of PEH are due to causes ‘amenable to effective health care interventions’.
The study found that the non-clinical atmosphere of community outreach settings improved communication between GPs and their patients, which in turn resulted in ‘stronger relationships and the breaking down of barriers’.
GPs were also able to tailor the sessions to the needs of the patients on the day, with participants reporting feeling less rushed, despite SPHCCs often offering longer appointment times, the study noted.
In addition to their being sat in social spaces, the GPs were ‘indistinguishable from the staff/volunteers in appearance’, which the study found made them more accessible.
It said: ‘The GPs sat with the participants in the social spaces and were able to informally talk with people as they got food, drank tea and used the computers, encouraging them to come to see the GP.’
The researchers concluded that ‘GPs caring for PEH should seek to work with their patients to build an environment which supports the development of stronger doctor patient relationships within the confines of their current system’.
