Covid-19 has shone a very public light on a longstanding problem – health inequalities. Through Primary Care Networks (PCNs), we have the potential to shift the dial on inequality for the first time in decades. But, with a challenge as seemingly big and complex as this, where do you start and how do you make inroads when there are so many other priorities?
The triple aim of healthcare – better health and wellbeing for everyone; better care for all people; sustainable use of NHS resources – is about to become a legal duty, effectively legislating a shift in focus towards preventative care and better outcomes. Key to delivering it will be a successful approach to tackling the equalities gap and investing more in keeping people well for longer. That means a more holistic approach, tackling the root causes of physical and mental ill health earlier in the process, whether it’s working with young people and local communities to tackle knife crime or supporting families to help turn the tide on childhood obesity.
PCNs are ideally placed to lead this shift towards holistic care. Investment in additional roles has already led to a broader mix of expertise at PCN level, with social prescribers in particular building strong links with community groups and voluntary organisations. In many cases, PCNs have access to the people we most need to reach, as well as links with the wider health, social care and emergency services. Crucially, PCNs can access vital data to inform the needs of their population.
However, with so many competing priorities, there are important steps to consider that will help PCNs turn theory into practice and maximise the impact of new initiatives through shared learning:
- Start small but start somewhere: Think about the main challenges for your own population. Use the data across your network to identify and assess where you could have the most impact. For example, do you have a higher prevalence of respiratory disease? What are the causes? Could that lead to projects which look at tackling air pollution and poor-quality housing to intervene before issues become established health problems?
- Look before you leap: Don’t start your project too soon. Take time to develop a strong structure to manage the work and objectively challenge what you’re aiming to achieve. Seek input to help you – few things we do are completely new and there will be people both in the UK and overseas with expertise to share.
- Think people not patients: In the health service, we work with patients – but if we want to turn the tide on health inequalities and deliver preventative care, we need to de-medicalise some of the issues we’re trying to address and reach people before they become patients. This requires engagement with people and community groups, listening to the issues faced and hearing the potential solutions: being led by them in co-production and implementation.
- Design-in co-learning: Although there will be elements of a system or community that are unique, the issues affecting behaviour change and how we connect with our own environment don’t change fundamentally, and much can be gained from learning from others. Tackling health inequalities is a huge task. Projects are already chipping away at some of the issues, but this is happening in pockets. If we can connect those pockets together and build a co-learning community, we will be better placed to adapt, scale or connect initiatives to maximise the impact on patient outcomes across the country and make best use of NHS resources.
- Evaluate – from start to finish: Effective evaluation allows us to judge whether a project can be justified or scaled, what learning can be transferred, and when to stop initiatives that aren’t meeting intended outcomes. For evaluation to work well, you need to know what data to collect and start recording it from the outset. With the right information, we can extract useful lessons from multiple stages of a project, as well as overall outcomes, and apply learnings elsewhere.
Delivering better outcomes for people can’t be done by the health service alone, but we do need to be prepared to step beyond the traditional “consult-diagnose-treat” approach if we are to reduce the pressures and cost of acute services. Taking the lead on tackling health inequalities in partnership with social care, police, community groups and others gives PCNs the opportunity to focus on the most pressing challenges in their patch and deliver personalised, preventative services that reach those most in need.
Martin Charters is the director of Health Care Solutions at NHS Arden and GEM CSU, and senior responsible officer (SRO) for the Complete Care Community programme.