How can primary care help reduce health inequalities? Dr John Ford, University of Cambridge, and Dr Geoff Wong, University of Oxford, are launching NIHR-funded research to find out how actions taken in primary care services and GP surgeries around the country can affect health inequalities and what should change.

Four chronic conditions, cardiovascular disease, cancer, diabetes and Chronic Obstructive Pulmonary Disease (COPD), have the biggest impact on inequalities in life expectancy and the research aims to find out how actions taken in primary care can either increase the inequalities, or cut them.

Gaps in life expectancy persist between the least and most deprived areas of England, and life and death differences in disease rates and outcomes for different groups in the population have been starkly highlighted by the increased risks for minority ethnic populations during the COVID-19 pandemic.

Health inequalities are known to be driven not only by the conditions in which people live and work, but also by the healthcare they receive.

GP consultations account for 90% of the public’s contact with healthcare professionals in the UK and primary care acts as the main referral system for access to comprehensive healthcare. It’s a key lever through which health inequalities can either be exacerbated or mitigated and the NHS expects local healthcare planners to develop clear plans to enable primary care to reduce health inequalities.

But which primary care interventions and which aspects of routine practice are likely to increase or decrease inequalities?

The new study, called EQUALISE, aims to find out. The goal is to develop guiding principles that healthcare planners and GPs can use to reduce health inequalities, through better design of general practice services.

The EQUALISE study will focus on inequalities between groups that differ on the basis of socio-economic status, gender, ethnicity and/or other dimensions associated with discrimination. The study is a collaborative research project, bringing together the Universities of Cambridge, Oxford, Newcastle and NHS Cambridgeshire and Peterborough Clinical Commissioning Group. The team is supported by a panel of experts, including academic and practice GPs, health care leaders, and academics as well as by Healthwatch and patients’ and grassroot initiatives’ representatives.

The team will undertake a ‘realist review’ of the international literature, guided by expert views on what drives health inequalities in general practice. Then, working with doctors, health care professionals and commissioners, the team will develop guiding principles and a toolkit for GPs and health care leaders to help them tackle health inequalities.

The EQUALISE study, which is funded by the NIHR’s Health Services and Delivery Research, will provide key evidence needed by NHS organisations, including Clinical Commissioning Groups (CCGs), NHS England Integrated Care Systems and Primary Care Networks.

This study will give us the evidence we need to understand which interventions are likely to exacerbate or minimise inequalities, particularly in primary care. The goal is to understand what the most important factors are to consider when designing general practice services to reduce inequalities. We hope that in time every general practice service change, nationally or locally, will consider these principles to make services better and fairer.”

– Dr John Ford, Clinical Lecturer in Public Health, Primary Care Unit, University of Cambridge

Find out more

Updates on the EQUALISE study will be published on the study’s webpage

For questions about the study, please contact Dr Anna Gkiouleka