King's College London

Following the completion of the HEARTH study in 2023, which compared the effectiveness of four primary health care models for people who were homeless, an open access analysis paper has just been published by the British Journal of General Practice on the effectiveness of specialist and mainstream primary health care services for this population.

Overall, the study found that specialist health services, particularly health centres primarily for people who are homeless and mainstream general practices with enhanced and targeted services for this patient group, had more favourable outcomes.

Unlike mainstream general practices without additional services for patients experiencing homelessness, the specialist models offered flexible, holistic and well-integrated services, such as drop-in clinics, longer than customary GP consultations, on-site mental health and substance misuse clinics, and outreach services. Staff at the mainstream general practices cited insufficient resources as preventing more proactive work with patients who were homeless.

While mobile homeless health teams that held clinics in homelessness sector hostels and day centres scored high in patient satisfaction, they performed less well for other outcomes. Service delivery factors are likely to have been influential. The teams mainly consisted of nurses and neither included a GP, and therefore patients were encouraged to register with a local general practice. Hence, they received health care from two separate services at different sites. Participants in each mobile team were not registered at the same GP practice, and thus the nurses needed to coordinate care with several general practices. Lower scores for health screening and continuity of care suggest poor coordination between the mobile team nurses and some general practices.

This publication

Maureen Crane, Louise Joly, Blánaid JM Daly, Heather Gage, Jill Manthorpe, Gaia Cetrano, Chris Ford and Peter Williams (2024) 'Primary health care for people experiencing homelessness: the effectiveness of specialist and mainstream health service provision,' British Journal of General Practice 74(749): 568-572. https://doi.org/10.3399/bjgp24X740217 

About the HEARTH study

The HEARTH study, which was funded by the National Institute for Health and Care Research (NIHR),  was led by Dr Maureen Crane of the NIHR Health and Social Care Workforce Research Unit at King's as part of the Unit's Homelessness Research Programme. In October 2023,  the study's final report (258pp) was published along with two briefing papers, one for NHS primary care and integrated care commissioners (11pp) and one for NHS primary care managers and practice staff (14pp), which spell out the findings and implications for these professionals.

Read more about the study findings (news item at time of publication of final report).

Elsewhere in the Homelessness Research Programme at King's

We run the Homelessness series - an ongoing series of webinars on topics related to multiple exclusion homelessness. All welcome!

Earlier this year: launch event at King's, 30 April 2024, of the final report from: Evaluation of the Out-of-Hospital Care Models programme for people experiencing homelessness