Homelessness:
The challenge of homelessness and accessing healthcare
People who are homeless very often feel judged and unwelcome and will often not use GP services.
Shelter defines homelessness as not having a home.
You are homeless if you have nowhere to stay and are living on the streets. But you can be homeless even if you have a roof over your head.
You can be homeless if you do not have rights or permission to stay where you are, or you live in unsuitable housing.
You count as homeless if you are:staying with friends or family
staying in a hostel, night shelter or B&B
squatting (because you have no legal right to stay)
at risk of experiencing violence in your home
living in poor conditions that affect your health
separated from your family because you do not have a place to live together
Based on the above somebody experiencing homelessness is defined as being of 'no fixed abode' (NFA). This immediately provides individual with the challenge of not being able to provide proof of address or ID when registering with a GP. Whilst this is not legal practice it is understandable as practices serve a specified area and generally have more patients on the list than is ideal.
Anyone experiencing homelessness has a right to register with a GP. We have overcome this challenge by completing the registration form and emailing it to the GP rather than expecting the patient to try to do it themselves.
Alternatively, anyone experiencing homelessness may show the following to their chosen GP and should not be refused.
We are able to provide a 'care of' address via the homeless day centre or one of the hostels.
Other challenges of using general practice are
The expectation that someone homeless should be queuing or phoning surgery for an appointment at 8am. If they are awake all night trying to keep safe or wandering the street fearing attack, it is highly unlikely they will be considering calling the GP for an appointment at 8am! Practices may need to consider flexible support.
Understanding that someone experiencing homeless may not be an 'average' patient. Many have significant backgrounds which impact on health and well-being and the ability to provide for themselves.
For many, English isn't their first language – book language line!
Staff having no or little awareness of local homeless services and so not offering support services
10 minute appointments are not conducive to getting a full health and social history. How can general practice be more homeless friendly?
Have a high index of suspicion of depression and anxiety and a background of abuse. Take time to explore this alongside drug and alcohol issues.
Be non-judgemental – you don't know what this person has gone through.
Our service offers:
Advocate for those who are unable to articulate their need for themselves
Liaison with social services/hospital discharge Advice
Anything and everything!
If we don't know, we'll try to find out who does!
GP services: we work closely with a local practice to support client registration with primary care services. We facilitate on-going care where perhaps, clients may not see it as a priority. The Outreach GP (PELC) is available for those who are either not yet registered or are unable for other reasons, to access the registered GP appropriately.
We work with many other providers to support improved health and well-being in this vulnerable community. Partnership working is paramount as there are many areas of care in which we don't have expertise and thus support other teams as well as our own. Our priority is to ensure the safety of clients and staff and therefore appropriate PPE/equipment continues to be used during the course of contact with any of our clients.