Approach to health inequalities (North Lewisham PCN)

[Covid-19 highlighted] that there was a shift change to remote consulting/online consulting and that we were leaving behind the more vulnerable members of our patient population.

Dr Aaminah Verity, Lead for Health Inequalities, North Lewisham PCN

About the partnership

1. North Lewisham Primary Care Network (NLPCN) comprises of nine practices. It represents around 80,000 patients, with a high proportion of non-white residents.
   
2. In Spring 2021, the PCN team embarked on a programme to reduce health inequalities, improve trust and engage with the local community, within its surgeries and in the community.
   
3. The programme includes new access routes to improve access for patients, improving communication to patients about service changes and health promotion and improving the monitoring of those suffering from health inequality to drive their strategy.

What has gone well

1. NLPCN has a team dedicated to addressing health inequalities working across the health, care and third sector with Lewisham Council, Lewisham Public Health, Lewisham CCG, One Health Lewisham, Lewisham Homes and others.
   
2. New North Lewisham Community Forum is a space for the community and PCN to come together. The forum ensures North Lewisham’s agenda and action is prioritised and driven by the voice of the community.
   
3. 115 organisations and individuals mapped, and 32 organisations fed into an exercise to understand local health inequalities.

Challenges experienced and overcome

1. Funding for GPs and PCNs – many more GPs would be willing to take part.
   
2. Keeping HI high on the agenda for GP staff – lots of competing priorities and pressures, using ARRS roles not adding to practice staff burden.

Results

1. First area to have regular COVID-19 vaccine pop-up clinics hosted by the community.
   
2. Enhanced listening to the community led to ‘covid conversations’ being created to provide answers and address doubt and hesitancy.
   
3. Discussion at the forum has led to new working groups focusing community priorities for addressing inequalities: improving GP Access, Poverty and Housing.
   
4. Public Health Lewisham with the CCG/ICB are looking to scale up and expand the NLPCN community-based approach across six PCNs to include health equity fellows, community connectors and a community of practice.

What made the difference

1. Co-designing solutions with community organisations: NLPCN evaluates options with the community.
   
2. The PCN has pledged to work with the community and other partners: such as local authorities, housing and third sector to advocate for systems-wide change, and to produce a shift to place-based approaches that blend clinical and social factors in addressing health inequalities and inequities.
   
3. Dedicated resource: to addressing health inequalities and working in partnership with the community and community organisations.
   
4. Community link worker: who knows the community well and can build trust between NLPCN and the community.