Specialist healthcare services for people experiencing homelessness in England are facing rising demand, with patient numbers at London’s Great Chapel Street Medical Centre increasing by 30% over the past year. Data from the Office for National Statistics indicates that homeless individuals face significantly lower life expectancies—45 years for men and 43 for women—compared to the general population, alongside higher rates of chronic conditions such as tuberculosis and hepatitis C.
The Growing Crisis of Homeless Health
The scale of homelessness in England remains a significant public health challenge, with more than 380,000 people currently experiencing homelessness, according to data from the charity Shelter. Mortality rates among this population have reached record highs; the Museum of Homelessness’s Dying Homeless Project recorded 1,611 deaths in 2024, a 9% increase from the previous year.
Clinical outcomes for this group are starkly different from the general public. Research from the Pathway Partnership Programme shows that people experiencing homelessness are 34 times more likely to contract tuberculosis, 50 times more likely to have hepatitis C, and six times more likely to develop heart disease. These patients also utilize emergency departments at six times the rate of the housed population and experience longer hospital stays.
Barriers to Primary Care Access
Despite the NHS’s official guidance that patients do not require proof of ID, address, or an NHS number to register with a GP, many remain excluded from mainstream services. Dr. Claire Rees, an academic GP advanced fellow at Queen Mary University of London, noted that these registration hurdles remain a primary barrier to care and has advocated for a national policy change to explicitly prohibit practices from requesting such documentation.
Digitalization presents a further challenge. Paul Daly, practice manager at Camden Health Improvement Practice, reported that the push for online registration and app-based consultations often excludes homeless patients who may lack reliable internet access or smartphones. "We’ve had a lot of pressure to register people online but then we’d never see them," Daly said. His practice continues to prioritize in-person registration and allows the use of the practice address to help patients receive vital correspondence.
Models of Effective Care
Specialist health centers, such as Great Chapel Street Medical Centre, offer a "one-stop shop" model that integrates psychiatry, podiatry, legal advice, and sexual health services under one roof. Dr. Dana Beale, a clinical lead at the center, emphasizes that this wraparound approach is essential for patients who have experienced significant trauma and face complex social disadvantages.
For general practices looking to improve their outreach, several resources exist:
- Safe Surgery Scheme: Run by Doctors of the World UK, this initiative provides protocols and training to help practices register patients without requiring proof of address or ID.
- Fairer Practice Toolkit: Developed by the Royal College of General Practitioners, this resource offers over 100 actions to help practices address health inequalities and identify specific patient needs.
Dr. Kamila Hawthorne, emeritus professor at Swansea University and chair of the charity Pathway, suggests that while specialist services are ideal, mainstream practices can improve outcomes by fostering continuity of care and booking face-to-face appointments to build trust. As the NHS moves toward its 10-year health plan, clinicians stress that funding and resource allocation must better reflect the complex, multidisciplinary needs of the homeless population to address these persistent health inequalities.
Worth a look