Benefits of GP care in outreach settings for people experiencing homelessness: a qualitative study

Abstract

Background: Although people experiencing homelessness (PEH) have the worst health outcomes in society, they have a low uptake of primary care services. GP outreach has developed as a way of increasing access into primary care but little is known about the experience of patients receiving care in this way. Aims: 1) To explore homeless patients’ experiences of GP care in community outreach settings in UK; 2) To seek staff/volunteer views on the strengths and weaknesses of the GP community outreach services. Design and setting: A qualitative study with PEH and staff/volunteers working in 3 different community outreach settings in the UK. Method: Individual semi-structured interviews with 22 PEH and two focus groups with key staff/volunteers. Data was analysed thematically using framework analysis. Findings: GP outreach services better enabled PEH to access medical care and staff/volunteers valued GP support to promote, and facilitate access to, health care services. In particular, findings illuminate the high value that PEH placed on the organisational environment of the GP outreach service. Valued aspects of GP outreach were identified as: 1) comfortable, safe and engendered a sense of belonging; 2) convenient, opportunistic and a one stop shop; and, 3) being heard, having more time and breaking down barriers. Conclusion: Organisational environment is important in enabling PEH to engage with GP services. The physical and organisational environment of the outreach settings were the most important factors: they created a space between the GP and patients where professional barriers were flattened and facilitated a therapeutic relationship.

Identifying Challenges and Solutions to Providing Diabetes Care for Those Experiencing Homelessness

“…Incorporating dental care into an existing community health centre serving individuals experiencing homelessness led to improvement in the self-perception of oral health (Hawkesford et al, 2020). Outreach services have also been found to promote health literacy, increase connection with the healthcare system, and improve overall satisfaction with the healthcare system (Doran & Doede, 2020;Hirst & Cuthill, 2021), consistent with the suggestions of our participants. Our manuscript provides support for the importance of incorporating a "one-stop-shop" design into diabetes-specific programs, in addition to general primary care programs, and other targeted programs which have been studied previously (i.e.…”

A scoping review examining patient experience and what matters to people experiencing homelessness when seeking healthcare

“…Repeatedly, participants valued services that recognised the complexities relating to homelessness and which tailored services to meet their needs 33,34,47,53 . PEH greatly appreciated the social capital gained from health services, in particular positive social interaction, shared norms and decreased feelings of isolation 30,49,53 . Participants described experiences of institutional practices inconsistent with patient-centred care 31,50,55 , rushed treatment 35,51,52 and a lack of awareness of PEH and the complexity of their healthcare needs 28,29,51 .…”

Remote primary care during the COVID-19 pandemic for people experiencing homelessness: a qualitative study

“…As suggested in recent related research, there should be more of a focus on collaborative working within the NHS (including secondary care and community pharmacy) and other services, such as charities, hostels, alcohol and drug services and job centres that have specific knowledge and experience of working with people experiencing homelessness and other vulnerable groups. Specific training on inclusion health for reception staff across primary care and not just for clinicians and others working in enhanced services would also be beneficial (14,47).…”

“…The NHS Long Term Plan (2019) seeks to close the inequality gap and recommends prioritisation of underserved groups in primary care (12). Dedicated homeless and inclusion health services are available within mostly urban areas in the UK and they provide 'drop in' and out of hour's clinics and outreach healthcare (13)(14)(15). However COVID-19 has disrupted this model of care with telephone or video consultations recommended to reduce infections (16).…”

“…Digital transformation to remote services including triage, as well as consultations, also raises questions about how to support people to access the right type of consultation (face-to-face, phone, or video) appropriate for their needs. This has implications regarding clinician-patient relationships (14,(20)(21)(22)) such as relational continuity of care, which is viewed by The Royal College of General Practitioners (RCGP) as crucial in the diagnosis and treatment of conditions, especially amongst people with long-term or sensitive health conditions where stigma is often experienced (23)(24)(25).…”