Access to health services for people experiencing homelessness in Manchester, UK: a qualitative study.

Abstract

Homelessness is a significant social issue in the UK. A GP practice (name redacted) based in Manchester has provided a primary Homeless Healthcare Service (HHS) to people experiencing homelessness (PEH) for 21 years. To assess primary healthcare provision at this practice from the perspectives of PEH at homeless day facilities in the Greater Manchester area. A qualitative multi-method study, including unstructured observations, was performed. Twenty semi-structured interviews were conducted with either staff or volunteers, and an additional 20 semi-structured interviews were held with PEH at four fixed sites. These sites were homeless day centres, which had previous or current outreach services with the practice. Participants were asked about their knowledge and opinions of the practice, experiences with the HHS, and recommendations for improvements. Five inductive themes were identified, consisting of PEH's fears around communication, challenges navigating the health system, insufficient GP signposting, travel as a barrier to access, and the importance of outreach. Administrative, physical, and communication weaknesses were identified in the HHS. Recommendations for future improvements were categorised as administrative, physical, service provision, and communication. The practice can further develop communication and advertising through Manchester, clarify pathways to care for PEH, and increase outreach services to ensure improved access to services.