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Homeless people report being unable to register with primary care

Some patients commit crimes to be sent to prison to access specialist dependency services

Ingrid Torjesen

Tuesday, 16 July 2019

Homeless people report negative experiences of attempting to access mainstream health services, and in particular primary care, a study* published in the British Journal of General Practice shows.

Researchers from the University of Birmingham recently reported that homeless people are almost 60 times more likely than the general population to visit A&E, visiting at rates similar to that of people in their sixties.


The same group interviewed homeless people at three homeless shelters to find out about their experiences of getting help from the NHS. Anecdotal reports suggest people who are homeless are denied access and face negative experiences of primary health care, but there has been little research exploring this population’s views and experiences of services.

A total of 22 people who were homeless were recruited for the study. Although some participants described facing no barriers, accounts of being denied registration at general practices and being discharged from hospital onto the streets with no access or referral to primary care providers were described.

Services offering support to those with substance misuse issues and mental health problems were deemed to be excluding those with the greatest need.

One person questioned described committing crimes in order to be sent to prison to access health care.

High satisfaction was expressed by participants about their experiences at the specialist primary healthcare centre for people who are homeless (SPHCPH).

The researchers made a number of recommendations for mainstream general practice, including improved training and education of frontline staff emphasising that being of no fixed abode is not a barrier to registering, and provision of information about additional health and homeless services, so  staff can facilitate signposting to reduce fragmentation of services.

Dr Vibhu Paudyal, senior lecturer in clinical pharmacy at the University of Birmingham, said that sadly anecdotal stories of homeless people being denied access to mainstream GP services were confirmed and show how much work needs to be done to make primary care more inclusive for homeless people. Participants also often found access to mental health and substance misuse services challenging as many have dual diagnoses.


“While specialist healthcare services that are established across the country offer these patients some comfort, exclusion from healthcare pushed some of our study participants into repeat cycles of homelessness,” he said.

“Improving access and inclusivity and prevention work particularly during an earlier stage in the homelessness cycle is the only way forward to alleviate the health impact of homelessness, its repeat cycle, and thereby to minimise homeless people’s use of emergency department admissions and prevent unnecessary deaths.”


*Gunner E, Chandan SK, Marwick S, et al. Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK. British Journal of General Practice, 15 July 2019; bjgp19X704633. DOI: 10.3399/bjgp19X704633

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