Liverpool’s only enhanced GP practice for homeless people—combining hospital discharge teams, addiction rehab, and specialist primary care under one roof—is about to be put to a rigorous test of cost and impact. Why this matters: People experiencing homelessness face complex health needs and routinely fall through gaps in standard care, yet no national strategy exists to design services that actually work for them. This project fills that gap by generating hard evidence on what an integrated model achieves. If the research succeeds, it will produce a policy toolkit for commissioners and NHS planners, showing exactly how much the enhanced service reduces A&E visits and emergency admissions, and at what cost. That evidence could reshape how local authorities and Integrated Care Boards fund homeless healthcare across England—replacing guesswork with data on which service designs deliver better outcomes for a population that is currently invisible in most health datasets.
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Background People experiencing homelessness (PEH) are highly vulnerable - yet under-researched - facing complex needs and barriers to accessing routine services which negatively impact their health. There is no national strategy to monitor or design services that work well for PEH. Our project evaluates a unique enhanced primary care intervention for PEH in Liverpool, combining out-of-hospital discharge teams, specialised primary care and addiction rehabilitation, within a community general practice – the only such service in England to our knowledge. Aims and Objectives The aim of the project is to generate evidence about what works in enhanced primary care for PEH by examining the population served and the intervention's impact on primary and secondary healthcare use. The objectives are: Obj1. To understand PEH's needs and develop tools to improve access. Obj2. To estimate the intervention impact on acute and primary service utilisation. Obj3. To estimate cost-effectiveness versus standard care. Obj4. To translate findings into evidence-based homeless healthcare designs. Methods Our project consists of four interlinked work-packages (WPs). WP1: Understanding needs and service use (Obj1) Using Cheshire & Merseyside whole-population linked data of primary, secondary, community, mental health and social care services, we will develop a new algorithm to identify PEH across all dataset settings covered. Then we will use descriptive, graphical and time trend analysis to profile PEH characteristics, enabling targeted activities to enhance access. WP2: Impact evaluation (Obj2) We will use the cohort of WP1 to apply two quasi-experimental methods, difference-in-differences (DiD) and weighting to balance covariates. DiD compares the changes of outcomes in the treated group (PEH receiving the intervention following their becoming known as homeless) and in the control group (PEH without intervention), estimating the average treatment effect of the intervention on outcomes. The primary outcomes are A&E and emergency admissions. WP3: Economic evaluation (Obj3) We will explore the cost-effectiveness of enhanced primary care using a cost-consequence framework. We will estimate service provision costs and compare these against outcomes explored in WP2 and costs of healthcare utilisation. WP4: Embedding (Obj4) Using the collaborative outcomes reporting approach, we will conduct three stakeholder workshops to translate research findings (WP1-2-3) into recommendations for service design improvement, ensuring we present evidence in an actionable format. Anticipated Impact and Dissemination This project will enable better characterisation of PEH healthcare use and needs (WP1), understanding of the impact of enhanced primary care on such utilisation (WP2) and the relationship between costs and benefits (WP3), thus providing evidence to redesign services that better address needs and increase benefits to patients. To enable implementation of evidence we will engage stakeholders to produce a policy toolkit (WP4). We will publish findings in high-impact journals and relevant conferences. To influence policy and practice, we will target: 1) national policymakers and charities (e.g., Faculty for Homeless and Inclusion Health, Crisis) to improve health systems for homeless people; 2) local and regional commissioners and planners (e.g., NHS Integrated Care Board, Local Authorities) to integrate services; and 3) service providers, including charities and healthcare professionals, delivering direct support to homeless individuals.
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