Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2003 Jun;53(491):473–479.

Homelessness: a problem for primary care?

Anthony J Riley 1, Geoffrey Harding 1, Martin R Underwood 1, Yvonne H Carter 1
PMCID: PMC1314623  PMID: 12939894

Abstract

Homelessness is a social problem that affects all facets of contemporary society. This paper discusses the concept of homelessness in terms of its historical context and the dominance of the pervasive 'victim blaming' ideologies, which, together with the worldwide economic changes that have contributed to a fiscal crisis of the state, and the resultant policies and circumstances, have led to an increase in the number of 'new homeless' people. This paper attempts to challenge the dominant political discourse on homelessness. The widespread healthcare problems and heterogeneity of homeless people have a particular impact on health services, with many homeless people inappropriately accessing local accident and emergency (A&E) departments because of barriers inhibiting adequate access to primary care. A number of primary care schemes have been successfully implemented to enable the homeless to have better access to appropriate care. However, there is no consistency in the level of services around the United Kingdom (UK), and innovations in service are not widespread and by their nature they are ad hoc. Despite the successes of such schemes, many homeless people still access health care inappropriately. Until homeless people are fully integrated into primary care the situation will not change. The question remains, how can appropriate access be established? A start can be made by building on some of the positive work that is already being done in primary care, but in reality general practitioners (GPs) will be 'swimming against the tide' unless a more integrated policy approach is adopted to tackle homelessness.

Full Text

The Full Text of this article is available as a PDF (82.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abdul-Hamid W., Cooney C. The homeless. Postgrad Med J. 1996 Nov;72(853):667–670. doi: 10.1136/pgmj.72.853.667. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Alderman C. Community care: integration is beautiful. Nurs Stand. 1992 Feb 12;6(21):20–21. [PubMed] [Google Scholar]
  3. Amery J., Tomkins A., Victor C. The prevalence of behavioural problems amongst homeless primary school children in an outer London borough: a feasibility study. Public Health. 1995 Nov;109(6):421–424. doi: 10.1016/s0033-3506(95)80046-8. [DOI] [PubMed] [Google Scholar]
  4. Bird J. Homes hope and health. Nurs Stand. 1996 Oct 16;11(4):18–18. doi: 10.7748/ns.11.4.18.s37. [DOI] [PubMed] [Google Scholar]
  5. Black M. E., Scheuer M. A., Victor C., Benzeval M., Gill M., Judge K. Utilisation by homeless people of acute hospital services in London. BMJ. 1991 Oct 19;303(6808):958–961. doi: 10.1136/bmj.303.6808.958. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bunce C. Doctors complain about treatment of asylum seekers in Britain. BMJ. 1997 Feb 8;314(7078):393–393. doi: 10.1136/bmj.314.7078.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Burke-Masters B. M. The autonomous nurse practitioner: an answer to a chronic problem of primary care. Lancet. 1986 May 31;1(8492):1266–1266. doi: 10.1016/s0140-6736(86)91399-1. [DOI] [PubMed] [Google Scholar]
  8. Coombes R. Home sick. Nurs Times. 1996 Dec 18;92(51):20–21. [PubMed] [Google Scholar]
  9. Crane M. Old and forgotten. Interview by Tim Lineham. 1993 Jun 30-Jul 6Nurs Times. 89(26):16–17. [PubMed] [Google Scholar]
  10. Darbyshire J. H. Tuberculosis: old reasons for a new increase? BMJ. 1995 Apr 15;310(6985):954–955. doi: 10.1136/bmj.310.6985.954. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Double D. B., Wong T. Homelessness after discharge from psychiatric hospitals. Lancet. 1990 Oct 27;336(8722):1075–1075. doi: 10.1016/0140-6736(90)92552-s. [DOI] [PubMed] [Google Scholar]
  12. Elton P. Primary health care for the single homeless. BMJ. 1988 Sep 3;297(6648):624–624. doi: 10.1136/bmj.297.6648.624-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Featherstone P., Ashmore C. Health surveillance project among single homeless men in Bristol. J R Coll Gen Pract. 1988 Aug;38(313):353–355. [PMC free article] [PubMed] [Google Scholar]
  14. Firth K. Opening the door to homeless households. Health Visit. 1995 Mar;68(3):97–97. [PubMed] [Google Scholar]
  15. Garety P., Toms R. M. Collected and Neglected: are Oxford hostels for the homeless filling up with disabled psychiatric patients? Br J Psychiatry. 1990 Aug;157:269–272. doi: 10.1192/bjp.157.2.269. [DOI] [PubMed] [Google Scholar]
  16. Gaulton-Berks L. Homeless but not helpless. Nurs Times. 1994 Apr 13;90(15):53–55. [PubMed] [Google Scholar]
  17. Gaze H. Homelessness: hitting the streets. Nurs Times. 1997 Aug 20;93(34):36–37. [PubMed] [Google Scholar]
  18. Geddes J. R., Newton J. R., Bailey S., Freeman C., Young G. The chief scientist reports.... Prevalence of psychiatric disorder, cognitive impairment and functional disability among homeless people resident in hostels. Health Bull (Edinb) 1996 May;54(3):276–279. [PubMed] [Google Scholar]
  19. George M. A largely hidden problem. Nurs Stand. 1997 Jul 2;11(41):22–23. doi: 10.7748/ns.11.41.22.s39. [DOI] [PubMed] [Google Scholar]
  20. George S. L., Shanks N. J., Westlake L. Census of single homeless people in Sheffield. BMJ. 1991 Jun 8;302(6789):1387–1389. doi: 10.1136/bmj.302.6789.1387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Gibb E., Lucas B. Homelessness: Portakabin care. Nurs Stand. 1993 May 19;7(35):18–19. doi: 10.7748/ns.7.35.18.s41. [DOI] [PubMed] [Google Scholar]
  22. Goodburn A. A place of greater safety. Nurs Times. 1994 Jul 13;90(28):46–48. [PubMed] [Google Scholar]
  23. Gravelle H., Sutton M. Inequality in the geographical distribution of general practitioners in England and Wales 1974-1995. J Health Serv Res Policy. 2001 Jan;6(1):6–13. doi: 10.1258/1355819011927143. [DOI] [PubMed] [Google Scholar]
  24. Hamid W. A., Wykes T., Stansfeld S. The social disablement of men in hostels for homeless people. I. Reliability and prevalence. Br J Psychiatry. 1995 Jun;166(6):806–808. doi: 10.1192/bjp.166.6.806. [DOI] [PubMed] [Google Scholar]
  25. Hamid W. A., Wykes T., Stansfeld S. The social disablement of men in hostels for homeless people. II. A comparison with patients from long-stay wards. Br J Psychiatry. 1995 Jun;166(6):809–812. doi: 10.1192/bjp.166.6.809. [DOI] [PubMed] [Google Scholar]
  26. Hart J. T. The inverse care law. Lancet. 1971 Feb 27;1(7696):405–412. doi: 10.1016/s0140-6736(71)92410-x. [DOI] [PubMed] [Google Scholar]
  27. Hodes M. Refugee children. BMJ. 1998 Mar 14;316(7134):793–794. doi: 10.1136/bmj.316.7134.793. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Holland A. C. The mental health of single homeless people in Northampton hostels. Public Health. 1996 Sep;110(5):299–303. doi: 10.1016/s0033-3506(96)80093-x. [DOI] [PubMed] [Google Scholar]
  29. Jankowski R. F., Mandalia S. Comparison of attendance and emergency admission patterns at accident and emergency departments in and out of London. BMJ. 1993 May 8;306(6887):1241–1243. doi: 10.1136/bmj.306.6887.1241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Kumar D., Citron K. M., Leese J., Watson J. M. Tuberculosis among the homeless at a temporary shelter in London: report of a chest x ray screening programme. J Epidemiol Community Health. 1995 Dec;49(6):629–633. doi: 10.1136/jech.49.6.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Lamont D. W., Toal F. M., Crawford M. Socioeconomic deprivation and health in Glasgow and the west of Scotland--a study of cancer incidence among male residents of hostels for the single homeless. J Epidemiol Community Health. 1997 Dec;51(6):668–671. doi: 10.1136/jech.51.6.668. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Laws D. Homelessness: exploding a modern myth. Interview by Charlotte Alderman. Nurs Stand. 1992 Jul 8;6(42):20–21. [PubMed] [Google Scholar]
  33. Lee H., Goodburn A. Developing an integrated strategy to meet homeless families' health needs. Health Visit. 1993 Feb;66(2):51–53. [PubMed] [Google Scholar]
  34. Leff J. All the homeless people--where do they all come from? BMJ. 1993 Mar 13;306(6879):669–670. doi: 10.1136/bmj.306.6879.669. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Lester Helen, Wright Nat, Heath Iona, RGCP Health Inequalities Standing Group Developments in the provision of primary health care for homeless people. Br J Gen Pract. 2002 Feb;52(475):91–92. [PMC free article] [PubMed] [Google Scholar]
  36. Little G. F., Watson D. P. The homeless in the emergency department: a patient profile. J Accid Emerg Med. 1996 Nov;13(6):415–417. doi: 10.1136/emj.13.6.415. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Lowry S. Housing and health: health and homelessness. BMJ. 1990 Jan 6;300(6716):32–34. doi: 10.1136/bmj.300.6716.32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Marshall E. J., Reed J. L. Psychiatric morbidity in homeless women. Br J Psychiatry. 1992 Jun;160:761–768. doi: 10.1192/bjp.160.6.761. [DOI] [PubMed] [Google Scholar]
  39. Parsons L. Homeless families in Hackney. Public Health. 1991 Jul;105(4):287–296. doi: 10.1016/s0033-3506(05)80213-6. [DOI] [PubMed] [Google Scholar]
  40. Pollock L. Positively Parker Street. 1993 Apr 28-May 4Nurs Times. 89(17):18–19. [PubMed] [Google Scholar]
  41. Potrykus C. NHS bill: homeless people's health in jeopardy. Health Visit. 1990 Jun;63(6):186–186. [PubMed] [Google Scholar]
  42. Powell P. V. A 'house doctor' scheme for primary health care for the single homeless in Edinburgh. J R Coll Gen Pract. 1987 Oct;37(303):444–447. [PMC free article] [PubMed] [Google Scholar]
  43. Power R., French R., Connelly J., George S., Hawes D., Hinton T., Klee H., Robinson D., Senior J., Timms P. Health, health promotion, and homelessness. BMJ. 1999 Feb 27;318(7183):590–592. doi: 10.1136/bmj.318.7183.590. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Ramsden S. S., Nyiri P., Bridgewater J., el-Kabir D. J. A mobile surgery for single homeless people in London. BMJ. 1989 Feb 11;298(6670):372–374. doi: 10.1136/bmj.298.6670.372. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Riley Anthony J., Harding Geoffrey, Meads Geoffrey, Underwood Martin R., Carter Yvonne H. An evaluation of personal medical services: the times they are a changin'. J Interprof Care. 2003 May;17(2):127–139. doi: 10.1080/1356182031000081731. [DOI] [PubMed] [Google Scholar]
  46. Sclare P. D. Psychiatric disorder among the homeless in Aberdeen. Scott Med J. 1997 Dec;42(6):173–177. doi: 10.1177/003693309704200605. [DOI] [PubMed] [Google Scholar]
  47. Sey J. Nurse practitioners. Life on the streets. Interview by Charlotte Alderman. Nurs Stand. 1995 Nov 8;10(7):22–25. [PubMed] [Google Scholar]
  48. Shanks N. J. Medical provision for the homeless in Manchester. J R Coll Gen Pract. 1983 Jan;33(246):40–43. [PMC free article] [PubMed] [Google Scholar]
  49. Shanks N. J., Priest R. G., Bedford A., Garbett S. Use of the delusions-symptoms-states inventory to detect psychiatric symptoms in a sample of homeless men. Br J Gen Pract. 1995 Apr;45(393):201–203. [PMC free article] [PubMed] [Google Scholar]
  50. Shaw M., Dorling D. Mortality among street youth in the UK. Lancet. 1998 Aug 29;352(9129):743–743. doi: 10.1016/S0140-6736(05)60868-9. [DOI] [PubMed] [Google Scholar]
  51. Stevens A., Bickler G., Jarrett L., Bateman N. The public health management of tuberculosis among the single homeless: is mass miniature x ray screening effective? J Epidemiol Community Health. 1992 Apr;46(2):141–143. doi: 10.1136/jech.46.2.141. [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Tandon P. K. Health care for the homeless. J R Coll Gen Pract. 1986 Jun;36(287):292–292. [PMC free article] [PubMed] [Google Scholar]
  53. Thomas E. Unstable lodgings. Nurs Times. 1991 Jul 24;87(30):42–44. [PubMed] [Google Scholar]
  54. Toon P. D., Thomas K., Doherty M. Audit of work at a medical centre for the homeless over one year. J R Coll Gen Pract. 1987 Mar;37(296):120–122. [PMC free article] [PubMed] [Google Scholar]
  55. Victor C. R. Health status of the temporarily homeless population and residents of North West Thames region. BMJ. 1992 Aug 15;305(6850):387–391. doi: 10.1136/bmj.305.6850.387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Vostanis P., Grattan E., Cumella S. Mental health problems of homeless children and families: longitudinal study. BMJ. 1998 Mar 21;316(7135):899–902. doi: 10.1136/bmj.316.7135.899. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Warner L. Access to health. Homelessness. Nurs Times. 1992 Dec 9;88(50):42–44. [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES