We envisage that there are two key audiences:
- The staff who work within Deep End GP Practices
- The decision makers who control funding allocation.
Our aims are to:
- Develop a cohort of professionals working in primary care who have an interest and expertise in managing patients from the bottom decile: build a sense of community.
- Engage with those practices which look after blanket populations in the bottom decile, whilst recognising that the additional demands of working with this population mean that they often do not have the time and resource to develop different ways of working.
- Support health professional training, both undergraduate and postgraduate, to understand the health effects of inequalities and to offer positive reasons to choose to train and work at the Deep End.
- Attract staff, especially newly qualified doctors and nurses, to work in Practices with more challenging demographics.
- Advocate for funding allocation to take account of deprivation more meaningfully.
- Advocate for our patients to have to have the right services when they may lack the resources to advocate for themselves.
- Develop new ways of working to address need eg utilising social prescribing.
- Learn from experiences elsewhere and from what we do whilst we develop this project.
- Disseminate the learning to all primary care clinicians, as most have contact with patients who face the challenges of living in deprivation (so-called pocket rather than blanket, deprivation).
Whilst we recognise that addressing the challenges of health inequalities extends beyond the boundaries of a GP practice we feel that our best chance, as GP’s, to have a positive impact on reducing inequality is by targeting practice-defined populations.
We also recognise that most patients who live in the most deprived wards are registered in practices which are not defined as Deep End practices. There are, however, specific challenges of delivering care when the majority of your registered patients live there.
We know that planned healthcare resources are not targeted at the population who need the most. There is an established body of evidence which recognises those patients living in the most deprived decile of our population face health related challenges that the system struggles to meet.
Our failure to meet the health needs of these patients is recognised as an underlying factor in the universally poor outcomes seen when we look at overall population health in the North East of England.
- Deep End populations have significantly reduced life expectancy and spend a far greater proportion of their life in poor physical and mental health than patients in more affluent areas.
- They tend to engage less well with planned care and to present later in the pathogenesis of diseases, therefore experiencing poorer outcomes from a range of common conditions including cardiovascular health and cancer.
- Traditional ways of improving health services of the overall population do not sufficiently take into account the needs of this population and as a result inequality have widened inexorably. Providing better services has the unintended consequence of widening inequality by improving the service available to those who engage.
- The impact is that these patients disproportionately access emergency and urgent rather than planned care interventions. This has been highlighted by demographic data which demonstrations that the rise in admissions related to common conditions such as COPD and frailty are almost exclusively driven by increase in admission activity from patients who are in the bottom quintile of deprivation.
Therefore, it is important that all of us recognise our responsibility to improve and change how we deliver healthcare to this population. The Deep End research in Scotland gave an evidence base for the first time to the anecdotal experience of those working in these Practices and now is the time to build on the evidence to provide a coherent and powerful message that we have to change the way we deliver health care.