Bridging Gaps: Improving access to general practice for and with marginalised patients- “it’s quite joyful for us, it’s really improved our work”

Background People with severe and multiple disadvantage (SMD-combinations of homelessness, substance misuse, violence, abuse and poor mental health) have high health needs and poor access to primary care. Aim To explore perceptions and experiences of improving access to general practice for people with SMD in healthcare staff and people with lived experience. Design and Setting Bridging Gaps is a collaboration between healthcare staff, researchers, women with lived experience of SMD and a charity that supports them in a UK city. We co-produced a project to improve access to general practice for marginalised patients, that was further developed with 3 inner city general practices. Method We observed six collaborative service improvement meetings at three general practices and conducted documentary analysis of minutes of a further three meetings. We interviewed nine practice staff and four participants with lived experience. Three participants with lived experience and one staff member who supports them participated in a focus group. Data was analysed inductively and deductively using thematic analysis. Results Enabling motivated general practice staff with time and funding opportunities, galvanised by lived experience involvement, resulted in sustained service changes. These included: care coordinators and patient lists to support access to patients in greater need and an information sharing tool. The process and outcomes improved connections within and between general practices, support organisations and marginalised patients. Conclusion These co-produced strategies could be locally adapted and evaluated elsewhere. Investing in this different way of working may improve inclusion of marginalised groups, health equity and staff wellbeing. How this fits in This study builds on previous work showing that continuity of care, being able to develop a trusting relationship and being proactive are of particular importance in providing care to highly marginalised patients(4, 5, 6, 7, 8). This work describes co-produced strategies including using care coordinators, patient lists and an information sharing tool to support access and continuity to patients in greater need, in addition to rich contextual information on how to shift ways of working to achieve this. In addition to a small team focused on marginalised patients, this study supports the literature highlighting the need for a trauma-informed approach throughout the whole practice team. These co-produced strategies could be adapted and piloted in other practices and areas. Investing in this focused way of working may improve inclusion of marginalised groups, health equity and staff wellbeing.