You're not alone—the experience of becoming an advanced nurse practitioner in greater Manchester.: Acton Shapiro Consultancy and Research and the University of York; 2009

Advisory Council on the Misuse of Drugs. Drug-related harms in homeless populations and how they can be reduced. 2019. (accessed 26 October 2021)

Aldridge RW, Story A, Hwang SW Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet. 2018; 391:(10117)241-250

The impact of COVID-19 on people facing homelessness and service provision across Great Britain. 2020. (accessed 26 October 2021)

Bramley G, Fitzpatrick S. Homelessness in the UK: who is most at risk?. Housing Stud. 2018; 33:(1)96-116

More than a statistic: a peer-led consultation with people experiencing homelessness for the London Homeless Health Programme. 2016. (accessed 26 October 2021)

Campbell DJT, O'Neill BG, Gibson K, Thurston WE. Primary healthcare needs and barriers to care among Calgary's homeless populations. BMC Fam Pract. 2015; 16:(1)

Cole C, Wellard S, Mummery J. Problematising autonomy and advocacy in nursing. Nurs Ethics. 2014; 21:(5)576-582

Collinson S, Ward R. A nurse-led response to unmet needs of homeless migrants in inner London. Br J Nurs. 2010; 19:(1)36-41

Crisis. Number of rough sleepers in England soars by 165% since 2010. 2019. (accessed 26 October 2021)

Cowley A, Cooper J, Goldberg S. Experiences of the advanced nurse practitioner role in acute care. Nurs Older People. 2016; 28:(4)31-36

Doctors of the World. Registration refused: a study on access to GP registration in England. update 2018. 2018. (accessed 26 October 2021)

Doctors of the World. One year of safe surgeries! News article. 2019. (accessed 26 October 2021)

Docs Not Cops. Patients not passports. 2021. (accessed 26 October 2021)

Dolezal L, Lyons B. Health-related shame: an affective determinant of health?. Med Humanit. 2017; 43:(4)257-263

Dorney-Smith S. Piloting the community matron model with alcoholic homeless clients. Br J Community Nurs. 2007; 12:(12)546-551

Dorney-Smith S, Gill N. Improving digital health access for excluded groups. British Journal of Healthcare Management. 2017; 23:(8)354-356

Equalities and Human Rights Commission. The lived experiences of access to healthcare for people seeking and refused asylum. 2018. (accessed 26 October 2021)

Evans C, Pearce R, Greaves S, Blake H. Advanced clinical practitioners in primary care in the UK: a qualitative study of workforce transformation. Int J Environ Res Public Health. 2020; 17:(12)

Groundswell. Peer research. 2021. (accessed 26 October 2021)

Health Education England. Multi-professional framework for advanced clinical practice in England. 2017. (accessed 26 October 2021)

Heinen M, Oostveen C, Peters J, Vermeulen H, Huis A. An integrative review of leadership competencies and attributes in advanced nursing practice. J Adv Nurs. 2019; 75:(11)2378-2392

Homeless Link. The unhealthy state of homelessness. 2014. (26 October 2021)

Hooks C, Walker S. An exploration of the role of advanced clinical practitioners in the East of England. Br J Nurs. 2020; 29:(15)864-869

Jennings N, Clifford S, Fox AR, O'Connell J, Gardner G. The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: a systematic review. Int J Nurs Stud. 2015; 52:(1)421-435

Jezewski MA. Staying connected: the core of facilitating health care for homeless persons. Public Health Nurs. 1995; 12:(3)203-210

Kivimäki M, Batty GD, Pentti J Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study. Lancet Public Health. 2020; 5:(3)e140-e149

Lawler J, Maclaine K, Leary A. Workforce experience of the implementation of an advanced clinical practice framework in England: a mixed methods evaluation. Hum Resour Health. 2020; 18:(1)

Leary A, Maclaine K, Trevatt P, Radford M, Punshon G. Variation in job titles with the nursing workforce. J Clin Nurs. 2017; 26:(23-24)4945-4950

Luchenski S, Maguire N, Aldridge RW What works in inclusion health: overview of effective interventions for marginalised and excluded populations. Lancet. 2018; 391:(10117)266-280

Mackenbach JP, Stirbu I, Roskam AJR Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008; 358:(23)2468-2481

Fair society, healthy lives. 2010. (accessed 26 October 2021)

Health equity in England: the Marmot review 10 years on. 2020. (accessed 30 October 2021)

Martin-Misener R, Harbman P, Donald F Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: systematic review. BMJ Open. 2015; 5:(6)

McKenzie C, Manley K. Leadership and responsive care: principle of nursing practice H. Nurs Stand. 2011; 25:(35)35-37

Ministry of Housing, Communities and Local Government. Understanding the multiple vulnerabilities, support needs and experiences of people who sleep rough in England. 2020. (accessed 26 October 2021)

NHS England/NHS Improvement. The NHS long term plan. 2019. (accessed 3 November 2021)

NHS North West London. Rough sleepers: health and healthcare. A review of the health needs and healthcare costs of the rough sleepers in the London boroughs of Hammersmith and Fulham, Kensington and Chelsea, and Westminster. 2013. (accessed 26 October 2021)

O'Connell J, Gardner G, Coyer F. Beyond competencies: using a capability framework in developing practice standards for advanced practice nursing. J Adv Nurs. 2014; 70:(12)2728-2735

Office for National Statistics. Deaths of homeless people in England and Wales: 2019 registrations. 2020. (accessed 26 October 2021)

Oliver S, Leary A. Dimensions of clinical nurse specialist work in the UK. Br J Nurs. 2012; 21:(1)32-37

Paniagua H. Advanced nurse practitioners and GPs: what is the difference?. Pract Nurs. 2011; 22:(7)383-388

Poduval S, Howard N, Jones L, Murwill P, McKee M, Legido-Quigley H. Experiences among undocumented migrants accessing primary care in the United Kingdom: a qualitative study. Int J Health Serv. 2015; 45:(2)320-333

Rae BE, Rees S. The perceptions of homeless people regarding their healthcare needs and experiences of receiving health care. J Adv Nurs. 2015; 71:(9)2096-2107

Rogans-Watson R, Shulman C, Lewer D, Armstrong M, Hudson B. Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel. Housing, Care and Support. 2020; 23:(3/4)77-91

Standards for advanced level nursing practice.London: Royal College of Nursing; 2018

Runnels V, Hay E, Sevigny E, O'Hara P. The ethics of conducting community-engaged homelessness research. J Acad Ethics. 2009; 7:(1-2)57-68

Schneller K. Intermediate care for homeless people: results of a pilot project. Emerg Nurse. 2012; 20:(6)20-24

Seiler AJ, Moss VA. The experiences of nurse practitioners providing health care to the homeless. J Am Acad Nurse Pract. 2012; 24:(5)303-312

Stetler CB, Ritchie JA, Rycroft-Malone J, Charns MP. Leadership for evidence-based practice: strategic and functional behaviors for institutionalizing EBP. Worldviews Evid Based Nurs. 2014; 11:(4)219-226

Story A. Slopes and cliffs in health inequalities: comparative morbidity of housed and homeless people. Lancet. 2013; 382

Street Medicine Institute. Street Medicine Institute Student Coalition. 2021. (accessed 26 October 2021)

Stringhini S, Carmeli C, Jokela M Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet. 2017; 389:(10075)1229-1237

Sullivan-Bolyai S, Bova C, Harper D. Developing and refining interventions in persons with health disparities: the use of qualitative description. Nurs Outlook. 2005; 53:(3)127-133

Swartwout KD. Primary care NPs. Nurse Pract. 2016; 41:(8)46-50

Torrens C, Campbell P, Hoskins G Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: a scoping review. Int J Nurs Stud. 2020; 104

Ungpakorn R, Rae B. Health-related street outreach: exploring the perceptions of homeless people with experience of sleeping rough. J Adv Nurs. 2020; 76:(1)253-263

Guidelines for health related street outreach to people experiencing homelessness. 2021. (accessed 26 October 2021)

Williamson S, Twelvetree T, Thompson J, Beaver K. An ethnographic study exploring the role of ward-based advanced nurse practitioners in an acute medical setting. J Adv Nurs. 2012; 68:(7)1579-1588

Xue Y, Intrator O. Cultivating the role of nurse practitioners in providing primary care to vulnerable populations in an era of health-care reform. Policy Polit Nurs Pract. 2016; 17:(1)24-31

Taking advanced clinical practice to the streets: an evaluation of the benefits and challenges in homeless health care

11 November 2021
12 min read
Volume 30 · Issue 20


Homelessness in the UK continues to rise. People who are homeless are more likely to have poor health and die early, and face multiple barriers to accessing health care. Ten years have passed since the Marmot review recommended action on these disparities. In the context of significant health inequalities, advanced clinical practitioners (ACPs) offer a different approach to homeless health care, providing complete episodes of care in complex situations and leading in integrating multiple agencies, service development and strategic advocacy. ACPs can use their expertise in this specialty to deliver education that raises awareness and reduces prejudice. Their research skills can identify gaps and expand the evidence base to improve practice at local and national levels. However, ACPs must promote their own roles, work closely with people with lived experience and be supported by their employers to embrace all four pillars of advanced clinical practice for the full benefits to be realised.

It is well documented that a person's socioeconomic position in society dictates their quality of life, including health outcomes (Mackenbach et al, 2008; Stringhini et al, 2017; Kivimäki et al, 2020). In the last 10 years, the number of people sleeping rough in England has increased by 165% (Crisis, 2019). The impact of COVID-19 seen in unemployment, rent arrears and evictions of sofa-surfers has led to even more people living on the street and compounded inequalities (Boobis, 2020).

The NHS Long Term Plan recognises England's homelessness problem, identifying that new service models are needed to tackle health inequalities in this population. It also recommends expanding traditional roles to meet changing workforce demands (NHS England/NHS Improvement, 2019). This would include advanced clinical practitioners (ACPs), who demonstrate high levels of autonomy and clinical decision-making informed by the four pillars of: clinical practice; leadership and management; education; and research (Health Education England (HEE), 2017).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content