Letters Health care for the homeless Sir, The Manchester and Salford Health Care

district health authorities (North Man-chester, Central Manchester and Salford). The brief of this project is to improve the standard of health care provision available to homeless people in Manchester and Salford and to examine and recommend ways in which they can be channelled and integrated into statutory primary health care services. Surveys in the hostels in the area reveal-ed a high prevalence of chest, gastro-intestinal and skin diseases, and identified large numbers of people suffering from psychiatric and alcohol-related problems. There is still a high prevalence of pulmonary tuberculosis among hostel dwellers compared with the national average. Some health problems are directly related to the life-style of some of the homeless, for example foot problems, trauma and the adverse effects of mis-using tranquillizers and hypnotic drugs. Homeless people tend to cluster in city centres, where there may be no general practitioner cover and tend instead to use hospital accident and emergency depart-ments. The size, isolation and separation of most hostel-type accommodation militates against the integration of health care provision and local health services and general practitioners in particular have often expressed a fear of being in-undated with demand should they accept homeless patients onto their lists. The registration status of homeless peo-ple is complex and needs to be systematically checked with the assistance of the family practitioner committee ser-vice. Although most hostel residents are registered with general practitioners before they become homeless, the hostels are usually away from the original practice area. This means that many homeless peo-ple are registered as temporary residents with local general practitioners because it is anticipated that they are transient and will be moving on. A general practitioner attempting to work with the homeless on a full-time basis is in a very different situation from orthodox practice. Consultations are car-ried out in a variety of 'surgeries ' within the hostels and day centres, with widely varying facilities and degrees of privacy. There is no help from receptionists and the National Health Service records are kept in the individual hostels or carried around by the doctor