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Helping people who are homeless into GP practices

Helping people who are homeless into GP practices

Helping people who are homeless into GP practices

Monday, April 3, 2017

As most frontline workers will know, accessing a GP when you are homeless can be difficult as often the registration process is a barrier. Jane Cook, Clinical Lead for Healthy London Partnership’s London Homeless Health Programme, tells us about the work being done in London to try and tackle this.


Anyone in England has the right to register and be treated in a GP practice.


That ‘anyone’ includes people who are homeless. Being homeless is bad for your health. People living rough on London’s streets live half as long as the rest of the population and are five times more likely to use A&E services.
Rates of drug and alcohol dependence are very high. Mental health, dental health and foot health are often poor, and respiratory disease is common. People who are homeless may present with multiple and complex health issues including long term conditions such as asthma, diabetes, arthritis, heart problems, high blood pressure as well as being at risk of accidents and also having mental health problems. People may have health problems associated with substance misuse problems such as hepatitis and poor healing.  

More than a statistic, published by the Healthy London Partnership’s London Homeless Health Programme, and researched and written by homelessness charity Groundswell, provides powerful evidence of the issues that people who are homeless face in relation to health care. People who spoke to the researchers identified that one of the key issues was having problems in being able to register with a GP practice.

Being asked to provide proof of ID or address was often cited as a key barrier – even though NHS England patient registration guidance states that these are not required to register at a GP practice. Other barriers include discrimination, bureaucracy with many forms having to be filled in, inflexible systems, and language barriers.

GP practices must register a patient unless they have reasonable grounds to decline and not having proof of address or ID or a person’s immigration status is not a reasonable ground under NHS England’s guidance.

If a practice refuses a patient they need to record the reasons, and write to the patient explaining their decision.
The Healthy London Partnership’s London Homeless Health Programme has been working to make it easier for people who are homeless to register and get treatment in GP practices.

Working with Groundswell and London Healthwatch, the London Homeless Health Programme has delivered 20,000 ‘My right to access healthcare’ cards to shelters, day centres, drop in centres and other organisations across London since December 2016.

The cards are designed to be carried by people who are homeless and highlight that a fixed address, ID and a person’s immigration status are not needed to register with a GP. The cards include Healthwatch’s national helpline number which people can call if they continue to have problems registering.

The cards were sent out with a guidance sheet for day centre and shelter staff. This guidance covers the rights to health care . A resource pack will be launched by the London Homeless Health Programme within the next month and will be available on the website.

Working with homeless health charity Pathway, and with help from the Care Quality Commission and Cardboard Citizens, the London Homeless Health Programme have also published an online training package for GP receptionists and practice managers to equip them to support patients who are homeless. All GP practices in London have received information about the training and have been encouraged to make sure that their staff complete it.


The e-learner package which includes a film, slides and a quiz, highlight the issues faced by people who are homeless and the ways that GP receptionists and practice managers can help them to register and receive treatment. This can support health improvement for individuals, in managing presenting health issues as well as being able to access health checks, screening and immunisations. This will not only impact on the health of individuals but will also support people to access community based services.

Feedback so far from GP practices about the training has been positive, and we hope it will be a valuable tool in staff training.


If you are doing similar things in other parts of the country we would love to hear from you, email us at frontline@stmartinscharity.org.uk

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