According to the World Health Organization (WHO):
“Health inequities are systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies.”
As part of our workforce and patient safety investigations, our team recently visited a town in the north of England to observe how a primary care network (PCN) in a deprived area organises its services to meet the needs of disadvantaged people. The impact of what we saw, heard, and felt was humbling.
PCNs were established in England in 2019 so that GP practices can work together with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas in groups. This enables greater provision of proactive, personalised and coordinated services to local people.
We visited a PCN where the population life expectancy is lower than the UK average for men and women. Half of the PCN are in the poorest 20% of England’s population.
Working beyond traditional healthcare boundaries
This PCN uses their network as an opportunity to focus resources on what they see as barriers to people accessing healthcare. They work beyond traditional organisational boundaries and create links with the voluntary sector, government agencies, local authorities, faith, and other community outreach organisations. They involve people from populations who experience significant inequity in their service design.
We observed how the PCN are building trust and working collaboratively with their population, including ethnic minority communities, people with multiple health conditions, people who experience homelessness, drug and alcohol dependence, vulnerable migrants, and other socially excluded groups. During our visit, we saw how tackling health and social inequity helps bring meaning into people’s lives for both users of the services and the staff themselves.
The role of the workforce
The PCN recruits staff with a specific remit to improve health and reduce health inequity. These roles include social prescribers, health and wellbeing practitioners, child health and wellbeing leads, community matrons and mental health support workers.
The people in these roles and the supporting leadership seek to address gaps in services that vulnerable people experience and showed us the ways they are proactively tackling inequity. They create healthcare services around some of the basic needs of food, warmth, language, and reducing fear and isolation.
We observed how these roles bridge between general practice and those responsible for wider determinants, such as housing liaison officers, the citizens advice bureau and English speaking and writing skills.
One member of staff said:
“We are often told by the people we work with that they are treated like humans by us. If they miss an appointment, we don’t sanction them or drop them from the service…We are helping those, who for whatever reason at this time in their lives, can’t help themselves navigate through the system.”
We observed child health and wellbeing leads working in schools with young people at risk of experiencing problems in the education system. Observing interactions between these staff and young people evidenced the rapport and trust being developed. A teacher described the service as “life changing” for children and the wellbeing coach was nominated for a community hero award.
The food bank enabled us to see and hear the voice of people suffering the impact of food and fuel poverty. We observed how vulnerable people and families are identified by health staff, working with staff that run the food bank, to ensure they can access healthcare. We were told that developing trust and a collaborative culture takes time to enable the co-creation of person-centred solutions for these people and families.
An afternoon was spent with a group of people who had attended free drop-in English classes. These people described how the classes had helped them integrate into the community and specifically how to access healthcare, further education, and the volunteer and job market.
We spent time in a residential home observing the care of people at risk of lack of autonomy and how the community matrons are reaching in and minimising hospital admission, working with care home staff, social workers, and the residents’ families.
The case for patient-centred leadership
The improvements to the wider determinants of health, including housing, education, social inclusion and ‘reaching in’ to help people access services before reaching crisis were all evident. We saw organisations proactively collaborating to support meaningful improvements for patients and their communities.
Regions must understand their populations and ‘reach in’ to support people to ensure equal access to care. Our takeaway message for other areas is that the healthcare system needs to lead and work beyond traditional boundaries. This builds community relationships and helps to overcome the barriers that people experience to access the care they require. Strong patient-centred leadership can move the approach towards proactive healthcare services for communities and help to tackle health inequity.
Further reading
These HSSIB patient safety investigation reports touch on understanding population needs:
