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NICE: Do not penalise homeless patients for missed appointments

by Jess Hacker
6 October 2021

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Practices should not penalise homeless patients for missing appointments, NICE has said.

The new guidance, published today (6 October), warned NHS services against penalising people experiencing homelessness, on the grounds that these patients may not re-engage.

The ‘rigidity of appointment systems can lead to people being dropped from services if they miss appointments,’ it said, after finding evidence that some services handed out financial penalties.

‘Based on the committee’s experience, this is a major problem for many people experiencing homelessness and they agreed that services should show flexibility and understanding to facilitate engagement,’ it said.

‘The committee discussed the clear association between missed appointments and premature death and agreed that providing more flexible appointment systems and alternative ways of accessing care is therefore essential in improving outcomes.’

Instead, practices should connect with peer supporters and advocates who can help the person attend appointments or re-engage with care if they have missed their appointment.

The draft, out for consultation until November, is intended to improve the access to care services for people experiencing homelessness.

Produced with the Centre for Homelessness Impact (CHI), the document said that as refusals are ‘relatively common,’ commissioners and planners will need to support practices in reinforcing existing NHS guidance.

Practices must improve registration for homeless people

Practices must also ensure that processes are in place to support the registration of homeless patients, NICE warned after finding evidence some were being refused if they lacked ID or an address.

In also found that service providers reported that many local GP practices refused to register people without such documents, despite NHS guidance indicating it is not necessary.

It added that there was ‘good qualitative evidence’ that people experiencing homelessness faced challenges registering and were sometimes turned away.

‘Being denied access to GP services can further alienate, cause distrust and prevent already marginalised people from engaging with services,’ it warned, adding that ‘when people are refused access to GP services, they turn to emergency care services’.

Access must be improved

Dr Lígia Teixeira, chief executive of the Centre for Homelessness Impact who co-produced the document, said: ‘People who experience homelessness often have poorer health, especially mental health, and this guideline is an important step towards making health and social care services more accessible to them.

‘It is very important to ensure that their needs as individuals are met and the guideline shows how this can be done sensitively and flexibly.’

Dr Paul Chrisp, director of the NICE Centre for Guidelines, said: ‘People experiencing homelessness face significant barriers to accessing health and social care compared with the general population, which results in huge health inequalities.’

He said that a better understanding of the specific needs of these patients would translate to better access to appropriate services and improved outcomes.

A study published earlier this year highlighted the ways in which practices can make their services more accommodating to people experiencing homelessness, including working in community outreach settings.

In March of this year, early in the Covid vaccine programme the DHSC accepted a reprioritisation recommended by the JCVI which meant homeless people would be prioritised for vaccination.