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Clinical Effectiveness Group

New CEG and NHS initiative will help GPs provide better care for patients with wider problems that may be affecting their health

People living in more affluent areas of the UK live almost ten years longer than people in deprived areas1. Housing conditions, money, social isolation and understanding of health information all play a part by significantly impacting our opportunities to be healthy. CEG is working with NHS North East London to enable GP practices to understand which of their patients are affected by these ‘wider determinants of health’. This will give healthcare professionals a broader understanding of an individual’s needs and enable them to deliver better care.

Photograph of a clinician taking a patients blood pressure during a consultation at a GP practice

Around 500,000 adults in the London boroughs of Barking & Dagenham, City of London, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest will be asked four yes/no questions, either by text message or during a routine interaction with their GP practice. The questions will ask whether or not the person has problems with their housing (such as damp or insecure tenancy), has difficulty making ends meet, whether they are lonely, and whether they feel able to understand health information and advice. 

The yes/no responses will be accessible to doctors, nurses and other staff at the patient’s GP practice, giving them a fuller picture of the person they are supporting. The information will be visible in the patient health record so it can be used to tailor health recommendations during a consultation, or to signpost to services within the community that could help to address the patient’s circumstances directly. 

Aggregated data (that does not identify individuals) will also be shared with local authorities and NHS commissioners so they can anticipate and manage demand for services and develop new initiatives targeted in the localities that need them.

CEG clinicians and facilitators have co-designed the initiative with NHS North East London and will be providing GP practices with: 

  • A template text message, which will include the four questions for patients.
  • A search that practices can run on their patient records to identify people living in areas likely to have high levels of need – these patients will be prioritised to receive the text message, though some practices may send the message to a wider group.
  • A conversation template that GPs and other healthcare professionals can use during appointments with patients. This will record the same questions and responses as the text message.

The campaign starts in August 2023 and will run for two years, with a view to implementing the approach as routine in the longer term to help address health inequalities. Currently 80% of practices in the NHS North East London region have signed up to take part.

Keith Prescott, Programme Lead, Clinical Effectiveness Group, Queen Mary University of London, says: 
“Many people in north east London are living without some of the essential means for good health, like quality housing and good pay. We are working with local NHS teams to counter the impact of these wider determinants of health in the region. If you receive the text message, please respond – it will make a difference.  It will enable your GP to signpost you to services that can help, and also provide you with the best and most appropriate healthcare.” 

Dr Jagan John, a local GP and board member at NHS North East London, says: 
 "There are many different factors that can affect a person's health so taking a few moments to read and respond to these text messages will help us provide personalised advice to people in north east London that can support them to improve their wellbeing.  

"The information we receive will enable us to offer tailored health recommendations or signpost people to services that can offer them specialist support with a range of issues. It will also help us anticipate demand for services and to develop new initiatives that directly address the needs of our local communities."  

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