I read with interest Steve Ainsworth's article on access to GP services ('Left out in the cold', page 23, 11 March). It is too easy, however, to blame GPs for failing to address the health needs of homeless people.

In Brighton and Hove, with the largest number of homeless people per capita outside London, a survey of Big Issue vendors found that 42 per cent were not registered with a GP.

An application was made by South Downs Health trust and East Sussex, Brighton and Hove health authority for a salaried GP service to be provided under a first-wave Primary Care Act pilot.

In the first six months, 300 people have registered with the team of a GP, a nurse practitioner and a practice secretary. Due to the targeted nature of the service, we are able to provide daily drop-in surgeries, outreach clinics and build relationships with other agencies to encourage their clients to register.

Our patients often have complex health needs, resulting from living rough or in poor accommodation, often complicated by substance misuse or mental health problems. They need more than a five-minute appointment and visit the practice frequently.

The ease of access and flexibility of working is not so easily managed in mainstream general practice. We need to develop a range of models of primary healthcare provision.

Sarah Healey

Deputy nurse executive

South Downs Health trust