Building a Better Health Service


Inclusion Health – A Primary Care team with a difference

Homeless people are among the most marginalised in society and they have among the highest health care needs. The Homeless Primary Care Team is a model of inclusion health, which removes barriers to care.

The Safetynet Homeless Primary Care Team is funded by HSE Social Inclusion. Safetynet Primary Care is a medical charity.

Staffed by GPs, nurses and clinic support workers the Safetynet model comprises the following:
- In Reach clinics in emergency accommodation
- Outreach (using a mobile clinic)
- Hostel (home) visits
- Open access clinics

St James Hospital, the Mater Misericordiae University Hospital, HSE mental health teams, and homeless charities meet weekly with the Safetynet Homeless Primary Care team to coordinate care for people experiencing homelessness.

The HSE Values of care and compassion drive the model for those most vulnerable in our society. The team follows a principle that ‘goes further’ to engage those on the margins to improve health and wellbeing. Outreach GP and nursing services are provided to entrenched rough sleepers in a van converted into a mobile clinic.

The team culture exhibits dignity and respect for those on the margins who frequently expect little for themselves. The design of the service is based on equity and inclusion and deep understanding of health seeking behaviours among vulnerable groups.

The service model is appropriate for all urban centres with a homeless population. A web based electronic medical record system is shared among over 20 services engaging homeless clients. This is transferrable to other parts of the health care system where patients use multiple services.

Nine fully equipped GP and nurse clinics are provided weekly in homeless hostels and services providing care to approximately 500 homeless people monthly. Health problems encountered frequently include respiratory difficulties, mental illness, addiction and chronic and acute illness . The model includes open access clinics for others stigmatised in society without access to health care including Roma, drug users and migrants without means.

The project ‘s unique features include primary and secondary care multi-disciplinary team meetings,
follow up of all patients where ever they are rough sleeping and the web based electronic medical record system .

The service aims to treat individuals who have otherwise not engaged with health care services while breaking down barriers and building trust with homeless people who often have negative experiences in health services.

This project has successfully adapted the Primary Care model to meet the health seeking behaviour of homeless people, providing out of hours outreach services via mobile health units and
offering placements for GP trainees.

Homeless Primary Care Team (HPCT) which is part of Safetynet Primary Care, a medical charity, and funded by HSE Social Inclusion.