Special Interest Group (SIG) on Health Equity June news

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Greetings & news

Greetings from the WONCA Special Interest Group (SIG) on Health Equity. For this edition, we take a glance at GPs at the Deep End, which has and continues to strive for health equity in the most deprived areas of Scotland. In Global Focus, we take a look at studies from Guatemala, Sweden to India.
In addition, as part of the affiliation to the International Journal of Equity in Health subscribed members are also entitled to a 20% discount on publications at the International Journal of Equity in Health. Please see below for further information and details.

As always we welcome contributions from any of our members. If you would like to subscribe to our mailing list, please direct your interest to: SIGhealthequity@wonca.net. Finally, remember to keep a look out for upcoming Health Equity-related events in 2016.

A global focus on health equity

This series brings Heath Equity related research from Guatmala, Sweden, and India. Feel free to visit our affiliated journal: The Journal for Equity in Health for full text.

Focus: GPs at the Deep End

The ‘GPs at the Deep End’ project started in 2009 at a meeting of GPs working in the most deprived areas of Scotland. The aim was not to produce yet another report on widening inequalities in health, but to gather the views and experiences of experienced health professionals about the particular challenges faced in areas of high socio-economic deprivation. Led by Professor Graham Watt of the University of Glasgow and a steering group of over a dozen GPs, the Deep End has become an important advocacy group representing the 100 General Practices that serve patients in the most deprived areas of Scotland.

The first task was to gather evidence of the key issues, not through formal research but through practitioner experience, which provides evidence from parts of the health service that research tends not to reach. Using facilitated small group discussions with frontline Deep End GPs, the group produced a series of reports on specific health and social issues that are prevalent in Deep End communities (e.g. alcohol problems, mental health, vulnerable children and families).

The next step was advocacy, to transform this evidence into relevant action. In 2012, the Deep End GPs proposed six essential components (Box 1) to meet the needs of patients in very deprived areas, which became a package of twelve measures in the 2013 report “What can NHS Scotland do to prevent and reduce health inequalities?”.

BOX 1. Essential components to prevent and reduce health inequalities in primary care.
- Address the inverse Care Law through extra time in the consultation
- Making best use of serial encounters to improve patient’s health
- Linking with others by using GP as the natural hub of the local health system
- Shared learning through better connections across the front line
- Improving infrastructure to support front line staff
- Supporting leadership at practice and area level

Advocacy work in areas such as addictions, mental health, welfare benefits, and vulnerable families has led to new collaborations with key stakeholders. This has resulted in a number of promising pilot projects, including the National Links Worker Programme, a pilot of attached social workers, and closer working with housing and welfare rights officers.

Most recently, the Deep End has drawn attention to the inverse care law in the recruitment and retention of GPs, whereby practices in more deprived areas find it harder to recruit and retain GPs. They argue that there is a need to increase exposure of trainees to general practice in deprived areas; for trainees that have had such experience, working in a Deep End practice is not unattractive, but needs to consist of good organisation and good support from other healthcare professionals (as well as communal coffee breaks!).

Perhaps the biggest ‘success’ of the ‘GPs at the Deep End’ project so far has been in highlighting the idea that primary care – if not resourced and distributed to respond to the gradient of patient need across the social spectrum – will act to widen health inequalities. This is the inverse care law in action. As well as this vital advocacy work, all that primary care can do to improve health inequalities is to increase the volume and quality of care in deprived areas. Any national health service should be at its best where it is needed most and this aspiration is part of what keeps Deep End GPs going.

Dr David Blane
Academic GP, Glasgow
Member of 'GPs at the Deep End' steering group
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The WONCA SIG Health Equity is affiliated with the International Journal for Equity in Health. As well as keeping up to date with the latest research regarding health equity issues all over the world, members of the SIG Health Equity group can enjoy a 20% discount for publications at the affiliated journal. For further information can be found on their website.