Homelessness is associated with multiple health problems and premature death, and there is growing understanding that long-term homelessness is a health issue. Inadequate care for homeless people leads to increased expenditure, with a minority of homeless people making frequent use of emergency departments.Annual inpatient costs for a homeless person in England are estimated to be eight times higher than that for the housed population. Chronic homelessness is characterised by physical and mental ill health and, often, substance misuse. Primary care physicians have the skills to address these issues. A number of studies have examined housing interventions (such as Housing First) in homeless people with mental health disorders and HIV, but studies in those with medical disorders have not been reported. In 2010, a GP-led and nurse-led intervention involving a hospital ‘in reach’ team for homeless people at University College Hospital London was developed. This intervention, Pathway, involved GP ward rounds and nurse practitioner patient support with a weekly multi-agency meeting. An audit indicated reduced in-patient stay and an improvement in the quality of care.We assessed costs and benefits of the Pathway intervention in a randomised controlled trial in two UK centres.