Building Equitable Primary Care - a practical toolkit

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. 

A positive vision for equitable primary care

Two academic groups have independently looked at what works to address inequalities in and through primary care. EQUALISE (led by Dr John Ford of Queen Mary’s Clinical Effectiveness Group) 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.

Five guiding principles

Based on an 18-month review of published research, the EQUALISE study identified five guiding principles which mark equitable general practice:

• Connected - Interventions and services should be understood, designed, and delivered as connected components of coordinated action against health inequalities.
• Intersectional - Care should adopt an intersectional perspective to account for the different impact of services and interventions among patients according to their circumstances and experience of(multiple) disadvantage.
• Flexible - Care delivery should be flexible enough to make allowances for different patient needs and preferences in terms of time, accessible communication, location, and provided support.
• Inclusive - We need to cultivate an organisational culture that is less western-centric and normative to ensure that people are not excluded due to wrong assumptions about who they are, what they need, and how they ‘should’ behave.
• Community-centred - Everybody involved in care should have a say in how it is conceived, (re)designed, and delivered including clinical and non-clinical members of staff, patients, and their networks.

The EQUALISE study has been published in The Lancet Public Health. EQUALISE is a collaboration between University of Cambridge and Cambridge Public Health, led by Dr John Ford of Queen Mary’s Clinical Effectiveness Group, with funding from NIHR Health and Social Care Delivery Research programme (NIHR 130694).

Four practical steps

The FAIRSTEPS study provides an evidence-informed framework of four steps to guide the commission, design and delivery of interventions in primary care that aim to address health inequalities.

• STEP 1 - Define the group(s) experiencing inequity (may be more than one group; sensitive to local context and information about population)
• STEP 2 - Consider the issues (access and engagement; structures and processes of care; patient experiences; staff training and development)
• STEP 3 - Ensure key ingredients are included (how and why will it work; what principles need prioritising for it to be transformative)
• STEP 4 - Co-design the intervention (involve service users, ensure sensitivity to local context and resources, establish responsibilities, plan evaluation)

The study also provides a set of practical examples of interventions, prioritised by practitioners and patients, that have been tried and tested. FAIRSTEPS is led by the University of Sheffield. The work was commissioned by Health Education England and supported by Deep End General Practice Networks. More information about FAIRSTEPS is available via the University of Sheffield website.