Doing more for less? Analysis of the experience of primary care networks in socioeconomically deprived areas

This report explores the impact of national policies on PCNs in more deprived areas, using analysis of workforce and funding data, and interviews with PCN leaders about their experiences | The Health Foundation

Primary care networks (PCNs) were established in England in 2019, bringing together general practices into local groups to provide additional services to patients. Backed by extra funding, PCNs were expected to recruit new staff, deliver additional appointments and new services, and work to improve health and reduce health inequalities.

PCN leaders broadly welcome additional staffing and report that PCNs have enabled better collaboration between local general practices and links with other local services. But leaders also felt funding does not reflect the additional workload of caring for patients in deprived areas. Many spoke of challenges engaging patients facing multiple social and economic barriers to good health. In some cases, recruiting and retaining PCN staff in deprived areas was difficult.

PCNs in areas of high deprivation need funding that meets the greater needs of their populations. But with the right long-term resources, stability and organisational support, PCNs could represent an important route for addressing local health inequalities.

Full report: Doing more for less? A mixed-methods analysis of the experience of primary care networks in socioeconomically deprived areas

Raising the barriers: An action plan to tackle regional variation in dementia diagnosis in England

All-Party Parliamentary Group on Dementia

A dementia diagnosis is a fundamental first stage of the dementia pathway. Missing out on an early and accurate diagnosis can have a significant negative impact, for example limiting access to symptom management interventions, ultimately leading to poorer outcomes and increased health and social care costs. At present there is a difference of over twenty percentage points in the dementia diagnosis rates between the highest and lowest performing Integrated Care Systems (ICSs) in England.

This is a report of an inquiry that examined how the most deprived and rural communities are particularly adversely affected by this regional disparity. The inquiry’s findings show a complex picture in which issues ranging from variation in population health risk and dementia public health understanding, to the geographical spread of brain scans and transport networks all play a part in regional dementia related health disparities.

The report sets out a number of recommendations across the core themes of dementia diagnosis, data, workforce and public health messaging. Collectively these recommendations outline how dementia pathways can be strengthened to enable access and quality care across all settings, communities and regions in England so that all who need it can receive a timely and accurate dementia diagnosis.

Full report: Raising the barriers: An action plan to tackle regional variation in dementia diagnosis in England

Inequalities in mental health care for Gypsy, Roma, and Traveller communities: Identifying best practice

NHS Race and Health Observatory

Gypsy, Roma, and Traveller communities face some of the starkest inequalities in access to healthcare in England and experience dire mental health outcomes.

This report is a comprehensive review that explores a lack of mental health care provision for these communities; captures first hand insight; and highlights good practice examples from six effective services across England, most of them run by voluntary Gypsy, Roma and Traveller organisations. The report contains data, personal interviews and analysis, and includes recommendations for policy, practice and research.

• Main report: Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities – Identifying Best Practice
• Plain English Summary: Inequalities in Mental Health Care for Gypsy, Roma, and Traveller Communities
• Appendices

Access denied? Socioeconomic inequalities in digital health services

via Ada Lovelace Institute

This report seeks to understand how people who have lived experience of poverty and ongoing health concerns are impacted by health inequalities when interacting with patient-facing digital health services. The findings suggest a need for policymakers, health care leaders, and digital health service designers and developers to reconsider how they use data and how they design and deploy digital health services.

Full report: Access denied? Socioeconomic inequalities in digital health services

Health inequalities: Improving accountability in the NHS

Institute of Health Equity

This report examines current and past mechanisms and levers that enable and hinder accountability for health inequalities and analyses whether these accountability processes are sufficient to reduce health inequalities. It provides proposals to improve accountability for health inequalities across integrated care systems (ICSs). Views were gathered from senior managers in the NHS in England with experience and expertise in health inequalities. In addition, policy documents and relevant grey and academic publications were reviewed to inform the assessment of past and current accountability mechanisms.

Full report: Health inequalities: Improving accountability in the NHS

A positive vision for equitable primary care

The findings of two academic projects – EQUALISE and FAIRSTEPS – have been brought together to produce a toolkit for addressing unequal access to primary care | via Queen Mary University of London

Addressing inequalities in primary care is crucial for achieving high-quality healthcare for all. Primary care serves as the foundation of the healthcare system, being the first point of contact for most people seeking help. But unequal access to these services can perpetuate health inequalities. By addressing issues of access, we can ensure that everyone, regardless of their socioeconomic status, race, gender, or geographic location, has an equal chance of comprehensive and timely care.

Two academic groups have independently looked at what works to address inequalities in and through primary care. EQUALISE and FAIRSTEPS have produced a solution-focused toolkit that brings together the findings of the two studies to describe what equitable primary care looks like, and provide practical steps to help local decision makers address inequalities in health and healthcare.

Full detail: Building Equitable Primary Care – a toolkit for practitioners and decision makers

Dr John Ford of Queen Mary’s Clinical Effectiveness Group gives an insight into the development and recommendations of the toolkit.

Multidisciplinary teams in general practice: What this means for people experiencing health inequalities and frequent users of primary care services

Via National Voices

The model of general practice is changing and, at the core of this, general practice is moving away from a model of ‘seeing a GP’ to a model that is ‘consulting with the multi-disciplinary team’. This project set out to understand awareness and experience of multidisciplinary teams across two groups: frequent users of primary care services and those who experience health inequalities.  

The project found that: 

• There was a low level of awareness of multidisciplinary teams, including amongst people who frequently use primary care.  
• In the current context of pressures in primary care, people often felt that multidisciplinary teams were a cost reduction measure, rather than an initiative designed to improve their care. This was the case, even though most people reported positive experiences with individual members of the multidisciplinary team. 
• For some groups, particularly those who have experienced inequalities and barriers to primary care, the shift to multidisciplinary teams can be experienced as a further barrier to participation in health and care.  
• The major themes that emerged were the importance of embedding practice within multidisciplinary teams which build trust, valuing the time and energy of patients and setting clear and reasonable expectations of what primary care users can expect. 

The report presents these insights and makes recommendations on how to improve experiences of multidisciplinary teams within general practice amongst populations who experience health inequalities and frequent users of primary care services. In particular, the report highlights how primary care teams can build trust and assure people that general practice has oversight of their care.

Full report: A shift to multidisciplinary teams in general practice: What this means for people experiencing health inequalities and frequent users of primary care services

How digital exclusion impacts access to healthcare for people seeking asylum in England

via British Red Cross

This report finds that people seeking asylum in England are at risk of missing out on basic healthcare services because they have limited access to the internet and digital tools. Using a peer research approach, where refugees who have been through the asylum process interviewed people seeking asylum, the report provides a detailed picture of the barriers to online healthcare services. It highlights several barriers, including the affordability of devices and mobile data, a lack of Wi-Fi in asylum accommodation, and a lack of confidence in using technology and navigating websites in English.

The people interviewed for the report said they felt isolated and lonely as a result of not having digital access. Worryingly, some stated that a lack of digital access also meant they avoided seeking help for medical problems altogether or went straight to A&E, when they couldn’t get through to a GP. The charity warns this puts the health of people seeking asylum at risk and adds additional pressure to emergency services.

Full report: Offline and Isolated: How digital exclusion impacts access to healthcare for people seeking asylum in England

Press release: People seeking asylum at risk of missing out on basic healthcare services

Supporting clinicians to address health inequalities in practice

A study by the Royal College of Physicians (RCP) has found that most clinicians feel they haven’t received enough training on health inequalities and would like more as part of their medical education.

This report looks at clinicians’ confidence in talking about and understanding health inequalities – avoidable, unfair and systematic differences in health between different groups of people. Of the almost 1,000 clinicians surveyed, 67% of respondents had not received teaching or training in health inequalities within a training programme or as part of their degree, and only 26% felt confident in their ability to reduce the impact of health inequalities in their medical practice.

In two self-selecting focus groups following the survey, all participants were keen to access further education on health inequalities, specifically in understanding how they could help to reduce them in practice. They felt that better understanding the needs and experiences of marginalised groups would help them in a healthcare setting.

The RCP will be using insights from the survey to develop further educational tools and resources to support clinicians with practical ideas on reducing healthcare inequalities in their workplace.

Full detail: Supporting clinicians to address health inequalities in practice

Press release: Royal College of Physicians report shows majority of clinicians want to receive more training on health inequalities

Population health and health inequalities resources

Produced by Health Education England, these digital resources support population health, health improvement and tackling health inequalities.

The aim is to provide an updated comprehensive list of learning resources that help raise awareness of a range of areas that affect population health and impact on health inequalities and provide learners with tools to address these, to support health and care workforces with upskilling, training, and development.

The resources align to the NHS Long Term Plan and are designed to support workforces, many are also relevant to undergraduate health care learners.

Full detail: Population Health and Health Inequalities