Abstract

Background/Objectives: New models of care are needed to address the barriers people who use substances (PWUS) and/or experience homelessness face when accessing primary healthcare. This study reports findings from the evaluation of a six-month pilot of a mobile health clinic (MHC) co-delivered by primary healthcare, local government, and lived-experience recovery organisations in the North East of England, UK. Methods: Pragmatic mixed-methods process evaluation with data sources including a patient survey, overt observations, qualitative interviews, and routine patient data. Qualitative data were analysed using inductive and deductive thematic analysis; quantitative data were analysed descriptively. RE-AIM framework dimensions were applied to inform interpretation. Results: N = 164 patients accessed the bus between 1 April and 31 October 2025, with survey data indicating that most patients were PWUS (n = 96, 84%), with experience of homelessness (n = 67, 61%) and/or lived in the most deprived neighbourhoods, with complex physical and mental health needs (Reach). Patients expressed satisfaction with the service, valuing the compassionate and comprehensive support provided. There was qualitative evidence of further re-engagement with statutory healthcare following attendance on the bus (Effectiveness). Local organisations were mostly keen to be involved in the pilot, with participation benefiting from existing local relationships and infrastructure (Adoption). The flexible yet consistent approach of those involved in service delivery was viewed as positive. There was some uncertainty around the functions of the bus and the role of some delivery staff (Implementation). Limited funding was perceived as a barrier to sustaining the bus, alongside lack of capacity within local organisations (Maintenance). Conclusions: The study highlighted the positive impact that an MHC can have on this marginalised population and provides further evidence for the need for clinical care that provides relational support and attends to the social determinants of health. The study indicates the potential for interdisciplinary working to improve access to healthcare for PWUS, and underlines that delivering healthcare at a neighbourhood level is reliant on strong community networks. Wider system change is still needed to further support the population.