Title: Gparts - Alexandra Huey - General Practitioners in Primary Health can play in homelessness prevention
Funder: Public Health Agency, NI

Abstract: Summary: Homelessness is a lived experience for many across the United Kingdom and Ireland and is associated with poor health and wellbeing outcomes. General Practitioners (GPs) have contact with a broad spectrum of individuals daily, and there is potential for GPs to pick up patients at risk of homelessness before homelessness happens. This is only possible if we know the questions to ask and who to refer to. We recognise that this will be happening informally by some GPs already; however, this research study aims to make every GP feel equipped by introducing to regular practice the use of screening questions that are easy to recall when a consultation raises a concern about housing. We aim to achieve this by trialling a set of screening questions in a UK and Ireland primary healthcare that have already been developed and are in use in a North American context. We hope these will be something akin to the CAGE questionnaire for alcohol misuse. Background of the study: Homelessness is a huge problem across the UK and Ireland. In England between January and March 2021 68, 250 households received government help for housing issues, 36, 800 were homeless and the remainder were at risk of homelessness. During the same time frame 2717 homeless households in Northern Ireland received support from the Northern Ireland Housing Executive(Direct. 2021). Research has shown that homelessness results in poor physical and mental health outcomes(Pleace 2015). The health inequality slope has been well documented and describes that the frequency of most health conditions increases with increasing social deprivation. Alistair Story makes a stark comment on the health experience of the homeless compared even with the most socially deprived housed groups: “The health experience of the homeless is more akin to a cliff, with homeless people experiencing a significantly disproportionate burden of morbidity(Story 2013).’ Furthermore, research suggests that 50% of health outcomes are a result of social determinants and physical environment, the remainder attributable to an individual’s health behaviours and the medical care they receive(Hood, Gennuso et al. 2016). Primary and Secondary Care settings are therefore managing the disease burden associated with homelessness, and patients are experiencing the day-to-day realities. It is therefore in the best interests of clinicians to help in the campaign prevent homelessness where possible, both to prevent morbidity in their patient groups as well as reduce the burden of the health outcomes on the health service. It is obvious that GPs don’t have the time, skillset, or resource to resolve housing issues, what GPs do have, however, is day-to-day contact with the at risk where there is potential to pick up and refer on those with housing issues to the resources they need. Aims and objectives of the study: Choose a set of screening questions developed from previous research for a United Kingdom/Ireland context using a modified Delphi technique (The screening questions should identify those who might be at risk of losing their home and will pick up those experiencing homelessness, both groups should be referred using same pathway.) Trial the screening questions in Primary Care settings in the UK/Ireland. GPs will trial the tool in consultation where a housing concern is raised e.g., mental health, substance misuse, domestic violence, ex-prisoner, patient who grew up in foster care. Acceptability study with clinicians using the Sekhon framework following the trial of the screening questions


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: GENERIC HEALTH RELEVANCE