Access to Health Care

PRIMARY HEALTH CARE

Primary care is the term for the health services that play a central role in the local community: GPs, pharmacists, dentists and midwives. Primary care providers are usually the first point of contact for a patient. They also follow a patient throughout their care pathway. Primary Care Trusts (PCTs) in England receive budgets directly from the Department of Health.

ISSUES

Our SNAP data indicated that:

  • 94% of homeless people have access to a GP
  • 91% have access to dental care
  • 86% have access to nursing care

However the same data showed many agencies felt external services were inadequate, due to lack of availabilty or eligibilty for their client group. Please see section 9 of  the full SNAP report for more detail. Other research has also highlighted that access to GP services for rough sleepers across the country can be variable and in some cases poor. A Service-user Consultation report in 2008 by the Queen’s Nursing Institute Homeless Health Initiative and Groundswell found that attitudinal barriers were common among GP services.

As a result, although many homeless clients will have access to a GP, not all will go to a GP when they have a health problem. This can be due to:

  • perception of social stigma. The Groundswell and the Homeless Health Initiative reported that staff attitudes are the single largest deterrent to homeless people taking up services, with 54% quoting this as the reason they did not go to a GP or hospital
  • inflexibility of GP services (eg. requiring an address to register, lack of awareness about specific needs clients may have which can make keeping appointments difficult; waiting times etc.)
  • chaotic lifestyles of some clients, particularly those rough sleeping, and lack of accessible information can lead to a low awareness of their own health needs and prevent them accessing a GP when they require this service. Often clients need support from voluntary agencies (eg. day centre staff) to support them attend a GP – this is not always available in all areas

SECONDARY CARE

Key issues

Secondary care is often acute health care (elective care or emergency care) provided by medical specialists in a hospital or other secondary care setting. Patients are usually referred from a primary care professional such as a GP.

Because of the barriers to primary care, some homeless clients access A&E when health conditions have deteriorated too greatly or when this use is otherwise inappropriate. This is both time and cost inefficient as leaving health problems to crisis point necessitates longer hospital stays, and is more expensive to treat than preventative GP treatment.

Research by the Office of the Chief Analyst at the Department of Health found homeless people are 5 times more likely to use A&E than the general population. Homeless Link's Health Audit found that 42% cients had used A&E at least once in the past 6 months.  

Solutions

Removing the barriers into primary health care to provide more preventative treatment is a clear way to reduce use of emergency care to treat minor illnesses and injuries which have become entrenched or severe.

SNAP found that the majority of projects reported having problems with access to external services. While these figures do not distinguish between primary and secondary care, we would advocate for increased provision of primary care thus reducing the need for secondary care.

Joint working between the homelessness and health sectors is also a priority. Communicating across sectors and creating clear points of access for the agencies working with the homeless is also a priority.

Further information