People who are homeless or marginalised have poor engagement with mainstream healthcare services. The aim of this study was to explore patient and staff perspectives of a street-based, primary health service, to help identify factors influencing patient access and management. A qualitative study was undertaken from April to September 2016. Interviews (n = 27) explored patients’ experiences of accessing healthcare services. Interviews with allied service staff (n = 5) explored referral pathways and patients’ access to healthcare. Factors influencing patients’ willingness to access primary healthcare through the street health service were identified as doctor–patient empathy, better understanding of patient circumstances, fostering of social capital, facilitating referral pathways and supporting the transition to mainstream general practice as circumstances improve. Hospital discharge planning and follow-up management were identified as gaps in the continuity of service. Ease of access provided by a street-based health service facilitates access to the healthcare system for homeless and marginalised patients. <div class="hor-line"> </div>.