Primary health care services for single homeless people: defects and opportunities

Background. An innovative residential centre in west London during 1997-199 8 helped older rough sleepers leave the streets and resettle in conventiona l homes. Many clients presented with multiple physical illnesses complicate d by chronicity and poor management. The centre initially experienced diffi culties in obtaining health care for the residents, briefly relied on an A& E department for treatment of serious and minor ailments, and latterly was served by a GP practice supported by special funding. Objective. The aims of this study were to describe the problems of providin g at short notice primary health care services to a high-need group, and th e prospective opportunities for the delivery of the required care. Method. A monitoring study collected routine operational data, life histori es from 88 residents using a semi-structured questionnaire and information from 61 residents about their contacts with GPs before residence in the cen tre. Interviews were also conducted with the centre's staff, a Health Autho rity officer and a GP who treated the residents. Results. The medical care of the residents was a major concern. Many had ph ysical illnesses yet th ree-fifths had not seen a GP for more than 5 years. Many were not registered, even among those who recently had become homeles s. It was difficult to organize the residents' medical care and to access s pecial funding at short notice. When funding was secured, there were diffic ulties in contracting the service. Conclusion. Current registration and commissioning procedures are ill fitte d to provide primary care services to a high-needs group at short notice. P rimary Care Groups, special funding and contractual arrangements provide op portunities for GPs and primary health care workers to provide an improved service to marginalized and special needs groups. The responsibility to ide ntify and respond to exceptional needs should be clearly defined and alloca ted.