Pharmacy Homeless Outreach Engagement Non medical Independent prescribing (PHOENIx) for Severe and Multiple Disadvantage

People experiencing severe and multiple disadvantage (SMD), such as homelessness, substance use and criminal offending, have multiple intersecting unmet health and social care needs and high mortality rates, often due to street-drug overdose. Pilot randomised controlled trials (RCTs) suggest an integrated, holistic collaborative outreach intervention (PHOENIx) involving generalist-trained pharmacists, nurses or General Practitioners, accompanied by staff from third sector homeless organisations, may improve outcomes including reducing overdose.

Set in six areas of Scotland, 378 adults with SMD will be recruited and randomised (divided by setting and previous non-fatal overdoses) to PHOENIx intervention in addition to Usual Care (UC). Aiming to meet participants weekly for 9–15 months, PHOENIx teams assess and address health and social care needs while referring onwards as necessary, co-ordinating care with wider health and third sector teams. Pairings of clinicians and third sector workers support the same participants. During a person-centred consultation, in the participants’ choice of venue, and taking account of the participant’s priorities, the NHS clinician may prescribe, de-prescribe, and treat, for example, wound care, and refer to other health services as necessary. The third sector worker may help with welfare benefit applications, social prescribing or advocacy, for example, securing stable housing. 

The primary outcome is time to first fatal/non-fatal street-drug overdose at nine months. Secondary endpoints include health-related quality of life, healthcare use and criminal justice encounters. A health economic evaluation will assess cost per quality adjusted life year (QALY) of PHOENIx relative to standard care. A parallel qualitative process evaluation will explore the perceptions and experiences of PHOENIx by participants, stakeholders and PHOENIx staff. 

Results will be shared with participants, third sector homelessness organisations, health and social care partnerships, then peer -reviewed journals and conferences worldwide, from the first quarter of 2027. 

Trial Registration: ISRCTN12234059, registered on 20/2/2025.

Funded by: UKRI (MRC)

In partnership with: NHS Greater Glasgow and Clyde, NHS Ayrshire and Arran, Hannepin Medical Centre, Minnesota, NHS Highland, New Start Highland, UCL, NHS Lothian, Streetwork/Simon Community Scotland, NHS Grampian, Alcohol and Drugs Action (Aberdeen), Police Scotland, Scottish Prisons Service, Scottish Ambulance Service, Edinburgh Clinical Trials Unit, University of Glasgow, NHS Lanarkshire, Turning Point Scotland, Parish Nurses, Steeple Church, Dundee, NHS Tayside