Evaluating a specialist primary care service for homeless patients: a qualitative study

Background Homeless people often experience poor health, multi-morbidity and early mortality and experience barriers to accessing good quality care. Little is known about how best to provide specialist primary care for these patients. Aim To evaluate the care provided to homeless patients seen in a specialist primary care service. Design and Setting A qualitative evaluation of a city centre primary healthcare service for excluded and vulnerable people, such as rough sleepers, who find it difficult to visit mainstream GP services. Method Data on patient characteristics and service use were extracted from primary care records using electronic and free text searches to provide context to the evaluation. Semi structured interviews with 11 patients and 4 staff were used to explore attitudes and experiences. Results Patients had high needs compared to the general population. Patients valued continuity of care, ease of access, multi-disciplinary care and person-centred care. Staff were concerned that they lacked opportunities for reflection and learning, worried that low clinical capacity affected service safety and quality, and wanted more patient involvement in service planning. Conclusion Homeless patients’ complex health and social problems benefited from a specialist primary care service, which was thought to reduce barriers to access and treat potentially challenging patients in a non-judgemental way, and provide personal continuity of care in order to develop trust.