Barriers to Primary Healthcare for the Homeless: The General Practitioner's Perspective

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Abstract
Objective: The objective of this qualitative study was to examine in depth the barriers to primary healthcare for homeless people from the point of view of the general practitioner. Method: Semi-structured interviews were undertaken with twenty-five general practitioners in Birmingham, UK. The major themes in the topic guide were training, views of the homeless, practice policy and initiatives for providing primary care for the homeless. Results: Although factors relating to the practice (such as the role of the receptionist and practice workload) and to aspects of ‘the system’ (such as local and national policy) were mentioned, the major barriers related to aspects of the doctors themselves, particularly their attitudes towards homeless people and their consultation style. There also appeared to be a dichotomy in GPs’ attitudes and behaviours towards homeless patients. Conclusion: This study suggests that a major barrier to care for the homeless is the general practitioner himself, and that there may be a dichotomy in general practitioners' attitudes and consultation behaviour towards the homeless. This has implications for medical student training and methods of primary care service delivery to homeless people.