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Homelessness in the UK contributes to profound health disparities by disrupting continuity of care and limiting essential healthcare navigation. An estimated 4,667 people were rough sleeping in autumn 2024—a 20 percent rise since 2023—and many face complex medical needs without stable registration or community health support. This guide explains the main physical, mental and substance-related health challenges, explores systemic barriers such as GP registration difficulties and stigma, profiles effective service models from specialist practices to outreach teams, outlines relevant legislation and funding streams, highlights key organisations delivering inclusion health, and proposes actionable strategies to improve homeless access to care. By mapping relationships between homelessness, health inequalities and service provision, readers will gain a comprehensive toolkit for enhancing support, strengthening integrated care approaches and promoting equitable outcomes for people experiencing homelessness in 2025 and beyond.
Homeless individuals experience a triad of health challenges—physical illnesses, mental health conditions and substance misuse—that interact to amplify morbidity and mortality. Physical health issues often include respiratory infections, chronic wounds and cardiovascular disease due to cold exposure, poor nutrition and delayed treatment. Mental health problems such as depression, anxiety and psychosis arise from trauma, social isolation and chronic stress. Substance misuse may develop as a coping mechanism for psychological distress or as a consequence of street culture, further complicating physical and mental conditions. These interconnected challenges underline the urgent need for integrated community health approaches that address multiple medical and social needs concurrently.
To summarise the primary health burdens experienced by people without stable housing, consider this overview:
These core challenges set the stage for understanding how barriers to care exacerbate existing health inequalities and drive over-reliance on emergency and hospital services.
Homelessness increases exposure to environmental hazards and infectious agents, resulting in higher rates of pneumonia, skin infections and chronic conditions such as hypertension and diabetes. Lack of secure accommodation often means disrupted medication regimens and missed follow-up appointments, leading to preventable complications. For example, a person with insulin-dependent diabetes who loses refrigeration for supplies faces life-threatening blood sugar fluctuations. Addressing these impacts requires flexible service channels, including walk-in clinics and outreach nursing on the streets to deliver timely assessments and medication support.
High prevalence of depression, anxiety and psychosis among homeless people stems from cumulative adversity, loss of social support and traumatic experiences. Rough sleeping can trigger acute stress responses that evolve into chronic conditions if unaddressed. Limited access to counselling, fragmented referral processes and stigma within mainstream clinics further hinder timely intervention. Embedding mental health specialists in outreach teams and specialist GP practices can foster trust, reduce barriers and improve engagement with therapeutic services.
Substance misuse among homeless individuals complicates diagnoses, increases risk of overdose and undermines adherence to treatment plans for coexisting conditions. Drugs and alcohol can mask symptoms of mental distress or physical illness, delaying presentation until crises emerge. Harm-reduction interventions—such as needle exchange, supervised consumption sites and integrated detox support—are essential to reduce hospital admissions and support recovery. Collaborative care models that blend medical treatment with peer support enhance the likelihood of sustained engagement and improved health outcomes.
Homeless access to care is impeded by structural, social and communicative obstacles that erode timely registration and service utilisation. A major barrier is the requirement for a fixed address or photographic ID to register with a GP, which excludes those sleeping rough or in temporary accommodation. Stigma and discrimination within healthcare settings discourage engagement, while inflexible appointment systems and poor outreach limit access for hard-to-reach individuals. Without tailored pathways, many rely on emergency departments for urgent needs, driving up costs and fragmenting care. Overcoming these barriers demands policy change, staff training and flexible service delivery designed around the realities of homelessness.
Patient Perspectives on Primary Healthcare Access for Homeless Individuals in the UK
ABSTRACT: AbstractBackgroundAnecdotal reports of people who are homeless being denied access and facing negative experiences of primary health care have often emerged. However, there is a dearth of research exploring this population’s views and experiences of such services.AimTo explore the perspectives of individuals who are homeless on the provision and accessibility of primary healthcare services.Design and settingA qualitative study with individuals who are homeless recruited from three homeless shelters and a specialist primary healthcare centre for the homeless in the West Midlands, England.MethodSemi-structured interviews were audiorecorded, transcribed verbatim, and analysed using a thematic framework approach. The Theoretical Domains Framework (TDF) was used to map the identified barriers in framework analysis.ResultsA total of 22 people who were homeless were recruited. Although some participants described facing no barriers, accounts of being denied registration at general practices a
Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK, 2019
Barrier TypeSpecific ConstraintImpact on AccessRegistration RequirementFixed address or ID needed for GP listsPrevents formal primary care registrationStigma and DiscriminationNegative attitudes from some healthcare staffDiscourages help-seeking and follow-up appointmentsService InflexibilityRigid appointment slots and location-based clinicsLimits engagement for transient populations
These systemic barriers create cascading effects across the care pathway and underscore the importance of specialist models, outreach services and care navigation to bridge gaps in community health provision.
GP registration systems require proof of address and identity, which many people experiencing homelessness cannot provide. This administrative constraint forces some to seek temporary registrations or rely on emergency services, disrupting continuity of care. Enabling registration without conventional documentation—through alternative address verification or hostels and day-centres acting as proxy addresses—promotes sustained access to primary care and preventive services.
Experiences of judgmental attitudes or dismissive language by reception staff or clinicians discourage homeless individuals from re-attending appointments. Perceived stigma leads to delayed help-seeking, exacerbating health problems that could be managed earlier in community settings. Embedding inclusion health training, peer advocacy and patient-centred communication techniques within services can rebuild trust and improve engagement.
Traditional booking systems rely on phone calls or online portals, which are inaccessible to many people sleeping rough. Inflexible operating hours and fixed-location clinics fail to accommodate variable daily routines of homeless individuals. Introducing walk-in slots, mobile outreach and text-based appointment reminders enhances reach, ensures timely follow-up and reduces missed consultations.
Specialist healthcare models tailored to homeless access to care demonstrate marked improvements in both engagement and outcomes. Homeless health outreach services deliver primary care on the streets and in hostels, reducing reliance on emergency departments. Specialist GP practices offering longer appointment slots and multidisciplinary teams address complex health and social needs in one setting. Care navigators guide patients through referrals, ensuring continuity across primary, secondary and community health services. Finally, proactive hospital discharge planning prevents avoidable readmissions by linking patients with community resources and accommodation support.
To illustrate effective service types, consider the following comparison:
ModelCore FeatureKey BenefitSpecialist Homeless GPExtended consultations and multidisciplinary teamsIn-depth assessment of complex needsOutreach Healthcare ServicesMobile clinics and street-based nursingDirect engagement with rough sleepersCare NavigationDedicated staff guiding referrals and appointmentsEnhanced continuity and follow-up careDischarge PlanningCoordinated handover from hospital to communityReduces readmissions and supports housing links
These models demonstrate how targeted service design can improve health equity, reduce costs and reinforce integrated care systems across the UK.
Specialist GP practices allocate longer appointment times, house multidisciplinary teams and operate drop-in clinics to accommodate irregular attendance patterns. By integrating general practitioners, mental health clinicians and substance misuse specialists under one roof, these practices address co-morbidities simultaneously and reduce referral delays. This holistic approach enhances trust, lowers barriers and promotes sustained healthcare navigation for homeless patients.
Outreach teams bring primary care directly to streets, shelters and day centres, delivering wound care, vaccinations and chronic disease management where people already are. These mobile services circumvent registration hurdles and engage individuals who would otherwise avoid mainstream clinics. Establishing predictable outreach schedules reinforces continuity, supports relationship building and enables rapid response to emerging health crises.
Care navigators—often with lived experience of homelessness—support patients in registering with GPs, scheduling appointments and accessing social support. They coordinate referrals between primary, secondary and third-sector services, ensuring no one falls through cracks. By advocating on behalf of patients and providing practical assistance with forms and transport, navigators improve appointment attendance and adherence to care plans.
Effective discharge planning begins at admission with early assessment of housing needs and community support. Best practices include assigning a discharge coordinator, arranging follow-up primary care or outreach visits, and linking with local charities for emergency accommodation. This collaborative planning reduces readmissions, promotes recovery in a safe environment and aligns with the Homelessness Reduction Act duty to refer.
UK policy frameworks provide statutory duties and funding streams to improve community health for homeless populations. The Homelessness Reduction Act 2017 mandates a duty to refer individuals at risk of homelessness, including by NHS organisations. In October 2025, an £84 million government package, featuring the Rough Sleeping Prevention and Recovery Grant, bolstered local services over winter. Integrated Care Systems (ICSs) embed inclusion health as a strategic priority, aligning health, housing and social care budgets to tackle health inequalities comprehensively.
Legislation or FundingMain ProvisionYearHomelessness Reduction Act 2017Duty to refer at-risk individuals to housing services2017Rough Sleeping Prevention & Recovery GrantLocal authority funding for support services2025ICS Inclusion Health StrategiesCross-sector partnerships targeting homeless healthOngoing
The Homelessness Reduction Act 2017 requires public bodies—such as hospitals and prisons—to identify people at risk of homelessness and refer them to local housing authorities. This legal duty ensures early intervention, preventing housing crises and supporting continuation of care. For healthcare providers, embedding duty-to-refer protocols within discharge processes fosters integrated community health pathways.
In late 2025, the government allocated £84 million for rough sleeping prevention and recovery, alongside £3 million for drug and alcohol treatment grants. These funds enhance outreach teams, increase specialist GP capacity and expand peer-led support services. Allocations to local Integrated Care Systems enable targeted commissioning of inclusion health initiatives based on regional needs.
Integrated Care Systems unify NHS bodies, local authorities and third-sector organisations to plan and deliver health and social care collaboratively. By designating inclusion health as a strategic priority, ICSs allocate resources for specialist GP practices, outreach programmes and housing support, creating coherent pathways that address medical, mental health and social determinants simultaneously.
A network of charities and NHS teams forms the backbone of specialist homeless healthcare in the UK. Pathway charity leads on improving hospital inclusion health through research, education and policy advocacy. Homeless Link generates evidence and campaigns to influence service design and funding. NHS Homeless Health Teams embed specialist clinicians within Integrated Care Systems to deliver tailored medical, mental health and substance misuse interventions across regions.
Communities across the UK benefit from these key organisations:
Pathway charity produces clinical toolkits, hosts training programmes and leads a Faculty for Homeless and Inclusion Health, ensuring NHS staff adopt best practices in hospital and community settings. Their work reduces avoidable readmissions, standardises care pathways and amplifies the voice of people with lived experience to shape policy.
Homeless Link compiles annual statistics on rough sleeping and temporary accommodation, highlighting health inequalities and service gaps. Their advocacy campaigns influence government funding, promote evidence-based interventions and convene sector partnerships to drive systemic change.
NHS Homeless Health Teams embed within Integrated Care Systems, offering multidisciplinary services that include outreach clinics, specialist GP surgeries and co-located mental health and substance misuse support. By tailoring care to the realities of homelessness, these teams improve engagement, reduce emergency department use and promote community-based follow-up.
Improving homeless access to care requires multi-pronged strategies that remove administrative obstacles, reduce stigma and deliver flexible services where people live and gather. Healthcare providers can facilitate GP registration without standard ID by accepting letters from shelters or day-centres as proof of residence. Staff training in inclusion health and unconscious bias addresses discrimination. Extending outreach and offering walk-in and drop-in clinics enhances engagement with hard-to-reach individuals. Embedding care navigators and peer advocates within services strengthens trust and continuity of care.
Key strategic actions to promote equitable access include:
These measures dismantle barriers and establish sustainable pathways to community health and well-being.
Providers can accept documentation from homeless charities or shelters and use “no-fixed-address” registrations with local authority or day-centre confirmation. This flexibility ensures timely access to long-term primary care and preventive services, reducing reliance on emergency departments.
Implementing regular inclusion health workshops, appointing peer mentors with lived experience and embedding trauma-informed care principles reduces prejudice and builds a culture of empathy. Visible commitments—such as charters affirming non-discrimination—signal trustworthiness to patients.
Designing mobile clinics with predictable schedules, offering drop-in slots outside conventional hours and co-locating services—such as benefits advice and mental health support—creates one-stop access points. Outreach teams that include peer workers foster rapport, encouraging ongoing engagement and follow-through with care plans.
People experiencing homelessness and their support professionals commonly inquire about the root causes of care exclusion, the health risks of rough sleeping, the role of navigators in bridging gaps, and which charities offer specialist health support. Clarifying these queries strengthens knowledge, builds confidence in seeking services and informs policy and commissioning decisions that drive system-wide improvements.
Homeless people struggle to access healthcare because rigid registration requirements, stigma, and inflexible appointment systems exclude those without ID or fixed addresses. This structural exclusion forces reliance on emergency care and interrupts continuity, deepening existing health inequalities.
Rough sleeping exposes individuals to hypothermia, respiratory infections, skin ulcers and assault, while disrupted medication regimes heighten risk of complications from chronic conditions such as diabetes and hypertension. Combined with poor nutrition and stress, these factors contribute to a life expectancy decades below the general population.
Care navigators accompany patients through GP registration, referrals and benefit applications, ensuring no one falls through administrative cracks. By coordinating multidisciplinary services and providing peer-led advocacy, navigators enhance appointment attendance, medication adherence and long-term engagement with community health services.
Charities such as Pathway offer hospital discharge toolkits and training; Homeless Link publishes research and best-practice guidance; and local homeless health partnerships—including NHS Homeless Health Teams—deliver outreach clinics and specialist GP surgeries. Together, these organisations form a supportive network that bolsters community health and navigational pathways for people experiencing homelessness.
Data-Driven Outreach for Individuals Experiencing Rough Sleeping: Facilitating Connections to Essential Services
ABSTRACT: Rough sleeping is a persistent challenge for some of the most disadvantaged individuals in contemporary society. This paper details work undertaken in collaboration with Homeless Link (HL), a UK-based charity, to develop a data-driven methodology for improving the connection between individuals sleeping rough and outreach service providers. HL's platform has experienced exponential growth in recent years, generating thousands of alerts daily during periods of extreme weather; this volume overwhelms their current volunteer-based alert processing system. To address this issue, we propose a human-centred machine learning system designed to augment volunteer efforts by prioritising alerts based on the probability of establishing a successful connection with an individual experiencing rough sleeping. This approach tackles limitations in capacity and resources, enabling HL to process all incoming alerts swiftly, effectively, and equitably. Initial evaluations utilising historical data indicate that our methodology...
A recommendation and risk classification system for connecting rough sleepers to essential outreach services, H Wilde, 2021
Homeless individuals face intertwined physical, mental and substance-related challenges that demand coordinated policy, specialist models and flexible community health services. By dismantling registration barriers, combating stigma, embedding outreach and navigator roles, and leveraging legislative duties such as the Homelessness Reduction Act, healthcare providers can significantly improve outcomes. Collaborative efforts among the NHS, local authorities, charities and peer-led initiatives establish robust pathways to equitable care, reduce emergency admissions and promote sustained well-being for people who are homeless across the UK. Continuous monitoring of funding, legislation and service innovations will ensure that this guide evolves in step with emerging needs and best practices in 2025 and beyond.
