GPs at the Deep End: Identifying and addressing social disadvantage wherever it lies

Sturgiss, Elizabeth; Tait, Peter; Douglas, Kirsty; Chew, Joo Inn; Baglow, Susan; Watt, Graham

doi:10.31128/ajgp-06-19-4960

Cited by 8 publications

(17 citation statements)

References 4 publications

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“…There has also been useful front-line research on patient experience and medical experience in the tradition of Tudor Hart, which is especially useful in assessing and understanding inequality in the quality of care given the limitations of quantitative metrics. [41][42][43] A complete ICL operates within almost all low-and middle-income countries, which usually have a high private expenditure share and/or highly fragmented systems of public funding with large urban-rural and employment-related differences in public coverage. In most cases the complete ICL remains when one restricts attention to publicly funded health care alone.…”

Section: Cross-country Comparisons Of Social Inequality In Health Care Deliverymentioning

confidence: 99%

The inverse care law re-examined: a global perspective

et al. 2021

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An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the health inequality reduction objective is kept in sight.

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Section: Cross-country Comparisons Of Social Inequality In Health Care Deliverymentioning

confidence: 99%

The inverse care law re-examined: a global perspective

et al. 2021

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“…Specific aims or objectives were not formally drawn up until a first meeting with the GPs who work at the 'Deep End.' One objective commonly included by Deep End groups was advocacy for both patients and GPs in areas of high need (28,31,34,35,37,39).…”

Section: Thematic Resultsmentioning

confidence: 99%

“…Securing funding has, however, not been a prerequisite to establishing a Deep End group. The Deep End groups in Canberra and Ireland have been established successfully without any major funding, with GPs attending in their own time (35,36). The difficulty of this model is it may exclude GPs with significant workloads, working 4-5 days a week from attending.…”

Section: -Secure Funding; Desirable But Not Essentialmentioning

confidence: 99%

“…A strong collaboration between academic and 'frontline' General Practice emerged. The initial Scottish Deep End Project sought to bring together GPs serving the most deprived areas, enabling the practitioner voice to be united (35). Subsequently, at least half, (five out of ten), of the groups are facilitated by academic GP colleagues based in universities (11,28,36).…”

Section: -Collaborate With Academic General Practicementioning

confidence: 99%

“…The results showed a mixed approach to those recruited and included within the different Deep End groups, with all groups being initially established and led by GPs. Most groups started exclusively with General Practitioners, as seen in Scotland (10,27,34), Ireland (36), North & West London(32) and Canberra (35). This, however, has evolved to include other allied primary care colleagues within primary care and General Practice teams, including frontline GPs, nurses, practice managers, researchers, educators, medical students and public health colleagues (11,31,33).…”

Section: -Decide On Membership Eligibilitymentioning

confidence: 99%

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Establishing a Deep End GP group: a scoping review

et al. 2022

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BackgroundGeneral Practitioners working in deprived areas, where all-cause mortality rates are higher, face unique challenges. Despite 50 years passing since Tudor-Hart’s seminal ‘Inverse Care Law’ paper, the health inequities gap is wide. ‘Deep End GP’ projects, are frontline General Practice led initiatives, working to close this gap, improving the health and lives of those most in need.AimTo use scoping methodology to map out the process of creating a ‘Deep End’ GP group.Design & SettingA scoping review using Arksey and O’Malley’s framework.MethodMEDLINE, EMBASE, Web of Science and CINAHL databases, as well non-peer reviewed publications, were searched and articles extracted, reviewed and analysed according to iterative inclusion criteria.ResultsFrom an initial search number of 35 papers, sixteen papers were included in the final analysis. Key steps in starting a Deep End group are: quantifying patients and practices in areas of deprivation; establishing GP led objectives at an initial meeting; regular steering group meetings with close collaboration between academic and frontline General Practice, as well as the wider multi-disciplinary team; adopting a local Deep End Logo.ConclusionDeep End GP groups have made advances to reduce health impacts of systemic health inequities. Starting a Deep End group involves a multidisciplinary approach, beginning with the identification of patients and Practices in areas of highest need. The findings and key themes identified in this scoping review will guide interested parties start the journey to do the same in their locality and to join the Deep End movement.

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Strengthening learning and research in health equity – opportunities for university departments of primary health care and general practice

Reath

Lau

et al. 2022

Aust. J. Prim. Health

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This paper explores the roles of university departments of primary health care (PHC) and general practice in promoting health equity. The coronavirus disease 2019 (COVID-19) pandemic has exposed long-standing health and workforce inequities in Australia, as elsewhere. Addressing these inequities will require wide-ranging responses particularly focussed on PHC and the PHC workforce. Well-resourced university departments of PHC and general practice have potential to lead research informing PHC transformation and strategies to reduce health inequity, as well as to train and inspire a future PHC workforce. Examples from such academic departments in Australia and internationally are briefly described, and the experience of a recently established department of general practice is considered, in order to recommend enablers including institutional support, curriculum design, and partnerships with communities and between institutions. Support for community-based clinical schools, practice-based research networks and strengthening PHC research capacity will enable the PHC and general practice academy to engage more effectively in addressing health inequity.

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GPs at the Deep End: Identifying and addressing social disadvantage wherever it lies

Cited by 8 publications

References 4 publications

The inverse care law re-examined: a global perspective

The inverse care law re-examined: a global perspective

Establishing a Deep End GP group: a scoping review

Strengthening learning and research in health equity – opportunities for university departments of primary health care and general practice

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