Since I’ve been working at Urban Village Medical Practice, with a specialist Homeless Healthcare service for Manchester’s homeless population, I’ve been amazed at the number of patients who come to us from outside the city looking for help because they’ve been refused access to their local practice.

A couple of weeks ago, when a young mum and her two-month-old baby came to the desk to register from six miles outside our catchment area, I discovered that she’d been refused registration at her chosen practice. She didn’t have a permanent address as she’d escaped domestic abuse and was staying with her sister. Her baby was due immunisations, hadn’t seen a Health Visitor, and the mother was looking for our help. I rang the Practice Manager of the practice that had refused to register her; she didn’t know her team were refusing registrations but did admit that they usually asked for ID with proof of address. However, this was a very vulnerable woman; she needed care and compassion and she’d been turned away.

It set me thinking about the myths about homeless healthcare and providing good services to our communities.

1. You need an address to register with a GP

There has never been a requirement to have an address to register with a GP. There are lots of ways around this. For example, we use our practice address for many of our patients but you can also use the postcode ZZ99 3VZ “No fixed abode” – however, using the practice address is preferred.

2. You need ID to register with a GP

You don’t need ID, an NHS number, or proof of address to register. Practices can ask for supporting documentation, but can’t insist on it. If you don’t have a permanent address, you can still register using a temporary address or the address of the GP surgery.

3. Homeless patients are hard to contact

Many homeless patients actually have temporary accommodation, jobs and live a “normal life” so are only as hard to contact as anyone else. Rough sleepers often have mobile phones, use community charging points and are happy to accept calls and messages. However, their lives are sometimes complex so it does take some effort to contact them. Telephone contact, and keeping updated with phone numbers from hospital letters and other contacts, is often the best way to keep in touch.

4. People experiencing homelessness create additional work

People experiencing homelessness have a significantly reduced life expectancy, they may have mental health and substance misuse issues, as well as long-term conditions. These are the people to whom we should give proportionately more of our time, as their health outcomes are worse.

Whether you know it or not, you’ll have people on your patient list who are homeless. That might be through a relationship break-up, it may be because of a cost-of-living increase, they may be sleeping on a friend’s couch, have moved back to their parents or are sleeping in their car. Being in a similar situation, where we might need additional help from healthcare services, is only a payday away for many of us.

5. They need specialist care

The CQC suggest that good practice includes the following.

“When caring for patients who are homeless or are at risk of becoming homeless, you could consider:

• introducing double appointments
• keeping prescriptions for as short a duration as possible
• ensuring clear boundaries for consultations are in place
• giving fast access to a named GP
• waiving any charges for housing letters or medical reports.”

Those considerations are the normal changes we’d make for someone with additional needs; our patients with learning difficulties and/or visual/verbal difficulties might get longer appointments or interpreters. We should just see those who are experiencing homelessness as another at-risk group, and one that we need to support differently.

All practices should register patients without confirmation of address and without ID, making it as easy as possible for the individual who’s asking for help. While there’s specialist care available in some areas of the UK with a high homelessness population, there are many people who are not living in permanent accommodation, but they’re not all rough sleepers

If you’re interested in providing a better service for your patients experiencing homelessness, Pathway is a good starting point with lots of information here.

You could have a look at what we do at Urban Village in our last annual report here, our recent Ockham podcast, or, of course, contact me directly.

Useful resources:

New patient registration & health check policy (England) [PLUS]
New patient registration & health check policy (Scotland) [PLUS]