Investigating local health inequalities using the Core20PLUS5 approach

Healthwatch Bristol, Healthwatch North Somerset and Healthwatch South Gloucestershire wanted to understand why people who are among the 20% most deprived in England and those who belong to marginalised communities are under-represented in receiving healthcare, and where it was possible about services that relate to the treatment of five common conditions. 

They explored the experiences of people living in the most deprived areas of Bristol and North Somerset in relation to accessing healthcare. The focus of their engagement activities increased our likelihood of meeting people with mental health issues, learning disabilities, recent immigrants, recent mothers, and those in homeless and traveller communities. They wanted to identify barriers these communities may be experiencing, in respect of how and when they access care and if they don’t access care, why.

Healthwatch spoke to 102 and logged 118 service related comments from people attending ten different local community groups in Knowle West, Hartcliffe and Weston-super-Mare about what prevented them getting help. 

Healthwatch found evidence of a combination of systemic barriers and failure to adequately accommodate individual access requirements, and these mainly accounted for individuals’ difficulties in accessing healthcare. Access to appointments in GP practices appears to be key as:

•  A significant number of people give up trying to make an appointment or their reduce health seeking behaviour. They say it is so difficult and too long a wait, reducing the opportunity for early diagnosis and timely intervention. 
•  The means of contact with GP practices i.e. triaging to manage demand creates feelings of being judged or stigmatised as the triage process asks people to justify wanting care. 
• Communication challenges including not being listened to or feeling ‘fobbed off’, and uncomfortable with using the available means of access.

There is evidence of people having a difficulty getting to places where health and care services are provided because; 

•  there was no provision locally 
• because of public transport cutbacks 
• They felt discomfort at being in an unfamiliar setting.

In contrast, where there is specific provision for marginalised groups this is valued and well-used. Examples include; a health visitor working with travellers and van-dwellers, who visits their sites and has built a rapport., and the Compass centre for homeless people, where care is accessible and relatively quick. In the recent past there were drop-in & GP walk-in centres open to all where people wait for care when they have to. 

Based on these findings Healthwatch have a number of suggestions for improving early diagnosis and uptake of services for people impacted by healthcare inequalities and especially those who have the Core20PLUS5 priority conditions include: 

• Choice of means of access – in person, online, telephone that allows more flexibility for patients to explain their concern in the way they can best manage. 
• A timely response to all patient-initiated contact 
• More flexible triage systems 
• Flexibility of appointment times and length with a mix of book-ahead appointments and on-the-day or within two days appointments 
• GP practices working with their Patient Participation Groups or local communities to co-produce an appointment system that works better for their patients and the practice
• Improved listening skills and training for receptionists to counteract stigma and subconscious prejudice. 
• Improved funding for GP practices working in areas of high need to increase provision of appointments. 
• Continued funding for tailored provision to marginalised communities. 
• More opportunities for patient-controlled access, such as drop-in, with opportunistic screening