General practice post-COVID-19: time to put equity at the heart of health systems?

Ashwell, Gemma; Blane, David; Lunan, Carey; Matheson, James

doi:10.3399/bjgp20x712001

Cited by 4 publications

(6 citation statements)

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“…While for many patients the technological solutions offer convenience and improve access, for others, such as those without a smartphone or Wi-Fi, or those with poor health literacy and with complex needs, they can present additional barriers and therefore increase health inequalities. 3,4 The impact of remote working on us as GPs also seems to be mixed. On one hand it allowed flexibility, which meant that shielded and isolating GPs as well as those at increased risk and with caring responsibilities could still work.…”

Section: Assessing Clinical Risk Remotely Requires Different Skillsmentioning

confidence: 99%

I don’t want to be a call centre GP!

Gregory

Brown²

2020

Br J Gen Pract

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General practice has not just remained open during the COVID-19 pandemic but responded with extraordinary agility and speed. This is not surprising as one of the key strengths of our speciality is its ability to adapt and innovate. We have a long track record of doing so: multidisciplinary working, electronic GP records, e-prescribing, call and recall systems, and, more recently, remote consulting and the speed with which we can identify and provide care to high risk and vulnerable patients.Continuity of care and knowledge of our patients and local communities have greatly assisted such a quick response. Although the majority of our consultations became remote, 1 we did not! On the contrary, by working within our local extended teams we enabled connections.

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Section: Assessing Clinical Risk Remotely Requires Different Skillsmentioning

confidence: 99%

I don’t want to be a call centre GP!

Gregory

Brown²

2020

Br J Gen Pract

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“…These concerned mostly an increased sense of community that emerged in several places through the implementation of vaccination programmes and public health initiatives which brought together general practices, local councils, faith leaders, community groups and charity organisations. 65 The 'Everyone In' initiative for rough sleepers is such an example: GPs worked together with local councils and other actors to protect those experiencing or being at risk of rough sleeping from the spread of COVID-19. 66 Similarly, vaccination programmes across Crawley, east Surrey and mid-Sussex run by the GP Federation, Alliance for Better Care (ABC), included an explicit orientation towards equity in vaccination uptake, local partnerships with small voluntary sector organisations and charities, and a mentality of working with people to reach populations who have been historically marginalised by healthcare services (e.g.…”

Section: Social Context: General Practice In the Times Of The Covid-1...mentioning

confidence: 99%

Reducing health inequalities through general practice: a realist review and action framework

Gkiouleka,

Wong,

Sowden

et al. 2024

Health Soc Care Deliv Res

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Background Socio-economic inequalities in health have been in the public agenda for decades. General practice has an influential role to play in mitigating the impact of inequalities especially regarding chronic conditions. At the moment, general practice is dealing with serious challenges in relation to workforce shortages, increasing workload and the impact of the COVID-19 pandemic. It is important to identify effective ways so that general practice can play its role in reducing health inequalities. Objectives We explored what types of interventions and aspects of routine care in general practice decrease or increase inequalities in health and care-related outcomes. We focused on cardiovascular disease, cancer, diabetes and/or chronic obstructive pulmonary disease. We explored for whom these interventions and aspects of care work best, why, and in what circumstances. Our main objective was to synthesise this evidence into specific guidance for healthcare professionals and decision-makers about how best to achieve equitable general practice. Design Realist review. Main outcome measures Clinical or care-related outcomes by socio-economic group, or other PROGRESS-Plus criteria. Review methods Realist review based on Pawson’s five steps: (1) locating existing theories, (2) searching for evidence, (3) selecting articles, (4) extracting and organising data and (5) synthesising the evidence. Results Three hundred and twenty-five studies met the inclusion criteria and 159 of them were selected for the evidence synthesis. Evidence about the impact of general practice interventions on health inequalities is limited. To reduce health inequalities, general practice needs to be: connected so that interventions are linked and coordinated across the sector; intersectional to account for the fact that people’s experience is affected by many of their characteristics; flexible to meet patients’ different needs and preferences; inclusive so that it does not exclude people because of who they are; community-centred so that people who receive care engage with its design and delivery. These qualities should inform action across four domains: structures like funding and workforce distribution, organisational culture, everyday regulated procedures involved in care delivery, interpersonal and community relationships. Limitations The reviewed evidence offers limited detail about the ways and the extent to which specific interventions increase or decrease inequalities in general practice. Therefore, we focused on the underpinning principles that were common across interventions to produce higher-level, transferrable conclusions about ways to achieve equitable care. Conclusions Inequalities in general practice result from complex processes across four different domains that include structures, ideas, regulated everyday procedures, and relationships among individuals and communities. To achieve equity, general practice needs to be connected, intersectional, flexible, inclusive and community-centred. Future work Future work should focus on how these five essential qualities can be better used to shape the organisational development of future general practice. Study registration This trial is registered as PROSPERO CRD42020217871. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130694) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 7. See the NIHR Funding and Awards website for further award information.

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“…The COVID-19 pandemic has further potential to influence UK-CEEs' access and experience of UK general practice. 36,37 Characterization of these factors is required to develop strategies to overcome barriers to engagement and improve satisfaction with general practice. 38,39 Scoping reviews increase the representation of community knowledge, allowing exploration and mapping of the extent, range and nature of scientific literature that may not otherwise be identified.…”

Section: Specific Healthcare Needs Of Uk Central and Eastern European...mentioning

confidence: 99%

“…As EU citizens, the Brexit referendum, negotiation process (2016–2020) and subsequent transition period have changed the perceived and actual legal position, rights and healthcare costs for CEE citizens in the United Kingdom. The COVID‐19 pandemic has further potential to influence UK‐CEEs' access and experience of UK general practice 36,37 . Characterization of these factors is required to develop strategies to overcome barriers to engagement and improve satisfaction with general practice 38,39 …”

Section: Introductionmentioning

confidence: 99%

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The perceptions of general practice among Central and Eastern Europeans in the United Kingdom: A systematic scoping review

Poppleton

Howells

Adeyemi

et al. 2022

Health Expectations

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Background: Around 2 million people have migrated from Central and Eastern Europe to the UK since 2004. The UK Central and Eastern European Community (UK-CEE) are disproportionately exposed to the social determinants of poor physical and mental health. Their health and healthcare beliefs remain under-researched, particularly regarding primary care. Objective: This review explores UK-CEE community members' use and perceptions of UK general practice. Methods: A systematic search of nine bibliographic databases identified 2094 publications that fulfilled the search criteria. Grey literature searches identified 16 additional relevant publications. Screening by title and abstract identified 201 publications of relevance, decreasing to 65 after full-text screening. Publications were critically appraised, with data extracted and coded. Thematic analysis using constant comparison allowed generation of higher-order thematic constructs. Results: Full UK-CEE national representation was achieved. Comparatively low levels of GP registration were described, with ability, desire and need to engage with GP services shaped by the interconnected nature of individual community members' cultural and sociodemographic factors. Difficulties overcoming access and in-consultation barriers are common, with health expectations frequently unmet. Distrust and dissatisfaction with general practice often persist, promoting alternative healthseeking approaches including transnational healthcare. Marginalized UK-CEE community subgroups including Roma, trafficked and homeless individuals have Health Expectations.

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General practice post-COVID-19: time to put equity at the heart of health systems?

Cited by 4 publications

References 0 publications

I don’t want to be a call centre GP!

I don’t want to be a call centre GP!

Reducing health inequalities through general practice: a realist review and action framework

The perceptions of general practice among Central and Eastern Europeans in the United Kingdom: A systematic scoping review

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