A Nation’s Health is Measured by Its Care for the Vulnerable

An RACGP and Public Policy Audit on Homelessness and Healthcare Equity

Executive Summary: A Moral and Practical Imperative

A country is judged by how it cares for its most vulnerable: children, the elderly, the frail, and those without a home. Homelessness is not just a housing issue—it is a healthcare crisis. The growing number of Australians experiencing homelessness represents a profound challenge to our national identity, public health system, and sense of social justice.

This document outlines a framework for General Practitioners (GPs) and policymakers to address the health inequalities associated with homelessness. It provides practical strategies for GP practices, systemic recommendations for the RACGP, and policy proposals for government action. The aim is to integrate healthcare and social care, ensuring that no Australian is left behind.

Section 1: The Crisis of Homelessness—A National Emergency

1.1 The Scale of the Problem

• On any given night in Australia, over 122,000 people experience homelessness.

• One in seven homeless individuals is a child under 12.

• 23% of the homeless population is between 12 and 24 years old.

• The number of people seeking homelessness services continues to rise, placing immense strain on social and healthcare systems.

1.2 The Human Cost of Homelessness

Homelessness is not just a statistic; it represents individual tragedies—families torn apart, mental and physical health deteriorating, and children growing up without stability or security. The consequences are generational.

Without adequate intervention, the cycle of poverty, trauma, and poor health deepens, costing not only lives but also billions in emergency healthcare, criminal justice, and social welfare expenditure.

Section 2: The Role of General Practice in Addressing Homelessness

2.1 General Practitioners as the Frontline of Social Medicine

GPs are often the only consistent point of healthcare for people experiencing homelessness. However, the current healthcare system is ill-equipped to support GPs in providing sustained care for this population. The fee-for-service model does not incentivize longer, more complex consultations, and social determinants of health are often overlooked in routine practice.

2.2 Barriers to Healthcare Access for the Homeless

• Lack of identification or Medicare details.

• Inability to book and attend scheduled appointments.

• Distrust of institutions due to past trauma.

• Poor mental health or substance use issues complicating engagement with services.

2.3 The RACGP’s Role in Driving Change

The RACGP must lead in advocating for policy shifts that empower GPs to provide accessible, trauma-informed, and sustained care to homeless populations.

Section 3: An Audit and Framework for GP Practices

To enhance care for vulnerable populations, GP practices can implement the following framework:

3.1 Accessibility and Affordability

• Bulk-billing for vulnerable populations (e.g., concession card holders, people without fixed addresses).

• Flexible appointment options (walk-ins, telehealth for those with access).

3.2 Staff Training in Trauma-Informed Care

• Mandatory training for all clinic staff on working with vulnerable populations.

• Cultural competency training for working with Indigenous and migrant communities disproportionately affected by homelessness.

3.3 Building Referral Pathways

• Establishing direct referral networks with housing services, mental health providers, and community support organizations.

• Creating a shared database of social support services accessible within GP software.

3.4 Follow-Up and Continuity of Care

• Implementing a “No Wrong Door” policy, ensuring patients who seek help are always connected to support, even if they do not fit typical service criteria.

• Developing a recall system to follow up with high-risk patients who may otherwise slip through the cracks.

Section 4: Systemic Change—Policy Recommendations for Government and the RACGP

4.1 Short-Term Reforms

1. Increase Medicare Rebates for Vulnerable Populations

• Introduce specific item numbers for extended GP consultations with homeless patients.

2. Expand GP Practice Incentives

• Implement Practice Incentive Payments (PIPs) for clinics providing care to homeless individuals.

3. Reduce Bureaucratic Barriers

• Simplify identification requirements for medical care access.

• Implement universal health access for children and young people at risk.

4.2 Medium-Term Goals

1. Integrated Care Hubs

• Establish community-based health hubs where GPs, mental health workers, and social workers collaborate to provide wraparound services.

2. Data-Driven Advocacy

• Collect and analyze national GP-led data on homelessness-related health outcomes to inform policy development.

4.3 Long-Term Vision: A Universal Right to Primary Care

• Healthcare should be a guaranteed right, not a privilege.

• A shift towards a hybrid social and healthcare model, where general practice is not just a business but a service prioritizing vulnerable populations.

Section 5: A Call to Action

For General Practitioners

• Embrace advocacy in your practice—small actions collectively drive systemic change.

• Engage with local organizations to build partnerships that support patient health beyond the consultation room.

For the RACGP

• Champion healthcare equity as a fundamental pillar of general practice.

• Push for funding reforms that prioritize care for disadvantaged populations.

For Policymakers

• Invest in primary care infrastructure that supports vulnerable Australians.

• Ensure homelessness is treated as a public health issue, not just a housing issue.

Conclusion: A Society Defined by Its Care for the Vulnerable

A truly civil society is measured by its care for those most at risk—children without stable homes, the elderly living in isolation, and those battling mental illness and addiction in the shadows of our cities. Homelessness is not an inevitability; it is a policy failure.

By integrating healthcare and social support, we can break the cycle of homelessness and inequality. A country that values its people must rise to this challenge—not out of charity, but out of justice.

The measure of a nation is not its wealth, but its humanity.

Paul Alexander Wolf