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Research update: Healthcare for the homeless

Research update: Healthcare for the homeless

Lucille Kelsall-Knight summarises a study about remote primary care for homeless people during the Covid-19 pandemic 

Remote primary care during the Covid-19 pandemic for people experiencing homelessness: a qualitative study1

Homelessness is a growing problem in England and other UK countries.2 Recent evidence shows widening health inequalities for homeless people, who face acute and ongoing complex mental, social and physical care needs.3 The NHS Long Term Plan (2019) seeks to address inequalities, recommending prioritisation of vulnerable groups in primary care4, but the pandemic forced changes in primary care. Remote consultations have become common, including for homeless people, possibly exacerbating inequality of access.

Howells and colleagues (2022)1 set out to explore the experience and impact of the changes in primary care in response to Covid-19, focusing on access to healthcare for people experiencing homelessness. They undertook individual semi-structured interviews with 21 homeless people, and 22 clinicians and support workers, at three case study sites between September 2020 and the end of January 2021. The sites were two commissioned primary care services and a community nurse inclusion service.

The interviews revealed difficulties accessing healthcare for homeless people, who did not always have access to a phone or the means to pay for a phone call. This meant additional work for support workers and clinicians in the community to provide or facilitate an appointment. The study participants felt there were challenges in maintaining a therapeutic relationship when conducting care remotely. Some felt remote appointments facilitated repeat prescriptions, but removed the ability to ‘drop in’ at their GP practice or day centre for a same-day appointment.

The main limitation of the study was that it only collected qualitative data; quantitative data may have provided more evidence on modes of consultation and the number of appointments.

The study concludes remote care should not be the default approach, despite having some advantages. Patients’ vulnerability and their clinical needs should be taken into consideration, as a relationship-based approach is important to addressing inequalities.

Lucille Kelsall-Knight is a lecturer in children’s nursing at University of Birmingham School of Nursing  


  1. Howells, K et al. (2022) Remote primary care during the Covid-19 pandemic for people experiencing homelessness: a qualitative study. BJGP 2022; 72 (720): e492-e500. Link
  2. Fitzpatrick S, Pawson H, Bramley G, et al. The homelessness monitor: England 2019. 2019. Link
  3.  Marmot M. Health equity in England: the Marmot review 10 years on. BMJ 2020; 368: m693. Link
  4.  NHS England. The NHS long term plan. 2019. Link


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