Primary health care for people experiencing homelessness: the effectiveness of specialist and mainstream health service provision

Introduction
Homelessness is a growing problem in many high-income countries, and physical health, mental health, and substance misuse problems are common among people affected.1,2 Many have multiple long-term conditions and their health needs are often greater than those of the general population. Since the 1970s, specialist primary healthcare services for people experiencing homelessness developed in the UK and elsewhere, generating debates about the benefits and drawbacks of specialist versus mainstream approaches.3,4 There have been few UK studies of the effectiveness of specialist provision, with the Department of Health in 2010 identifying a need for such evidence.5 The HEARTH study (2015–2023) aimed to address this knowledge gap by comparing the effectiveness of four primary healthcare models in England used by people experiencing homelessness. The models, identified by an initial mapping survey,6,7 were: 1) health centres primarily for people experiencing homelessness (Dedicated Centres); 2) mobile health teams that hold clinics in homelessness sector hostels or day centres (Mobile Teams); 3) mainstream general practices providing additional services for patients experiencing homelessness (Specialist GPs); and 4) mainstream general practices providing general medical services but no additional services for those experiencing homelessness (Usual Care GPs).
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This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).