Title: Right to care: improving access to primary care for inclusion health groups
Funder: Department of Health and Social Care

Abstract: Our aim is to improve national access to primary care by improving levels of GP registration for the most marginalised groups in our society including asylum seekers, undocumented migrants, gypsies, travellers, Roma, and people experiencing homelessness or substance use disorders. Collectively, these populations are termed inclusion health groups. First, we will co-produce, develop and test an awareness-based tool to support inclusion health patients with GP registration. Second, we will produce a training, resources and support programme for GP practices to facilitate the registration of inclusion health groups that can be scaled and tested in a national evaluation. Development work questions How can an awareness-based tool support inclusion health service users with GP registration? How can a training, resources and support programme for GP surgeries facilitate the registration of inclusion health groups? Background Although everyone living in the UK is entitled to access free primary care, inverse care persists for people in need of healthcare who are wrongly being refused access to GP practices. This problem is widespread and affects inclusion health groups everyday around the country. UCLH s Find&Treat (F&T) and Doctors of the World (DOTW) provide healthcare for inclusion health groups and work to effectively integrate them into mainstream NHS services. At present DOTW intervenes in two ways: first, it takes an advocacy-based approach by calling the GP to help register each individual and second, DOTW developed a Safe Surgeries (SS) initiative that helps GP practices register inclusion health groups. However, these interventions were developed to meet the needs of mostly migrants, are resource-intensive and have never been systematically evaluated. To better address the needs of inclusion health groups more broadly and expand DOTW s impact nationally, there is a need to build on and redevelop the current DOTW interventions in collaboration with homeless and inclusion health specialists at UCLH s F&T. Development work plan The development programme has two complementary work packages. First, we will develop an awareness-based tool for GP registration for inclusion health groups. This will include: a needs assessment of the existing DOTW advocacy-based intervention, hosting multi-stakeholder co-production workshops to design the tool, develop the tool, and a feasibility testing of recruitment and follow up strategies. Second, we will develop a scalable training, resources and support programme to facilitate inclusion group registration for GP surgeries. This will include: a programme evaluation of DOTW s Safer Surgeries (SS) initiative, hosting multi-stakeholder co-production workshops to design the new programme and subsequently develop it with input from service users, and a feasibility testing of the programme and evaluate scheme in a number of GP practices across the UK. Anticipated Impact and Dissemination The programme will help reduce barriers to GP registration at both the individual and practice level for inclusion health groups, leading to greater opportunities for illness prevention and early intervention as well as decrease the likelihood that these patients resort to unscheduled or emergency care. The findings of this grant will be disseminated through the relevant partners networks within both civil society, policy and research spheres.

Lay abstract: Background: Everyone living in the UK is entitled to access free primary care. However, GP practices commonly refuse to register people if they don't have proof of address, ID or because of their immigration status. This problem affects many of the most marginalised groups in our society, including asylum seekers, undocumented migrants, gypsies, travellers, Roma, and people experiencing homelessness or with substance use disorders. Collectively, these groups are termed inclusion health populations. Research shows that these groups have worse health outcomes than the general population and often do not have information on how to access the NHS or their rights. Barriers to access primary care often result in higher usage of expensive emergency care services. Outreach teams like UCLH s Find&Treat (F&T) and Doctors of the World (DOTW) provide healthcare for inclusion health groups in the community and work to effectively integrate them into mainstream NHS services. DOTW helps service users register with a GP in two ways: first, by calling the GP to help register patients and second, by helping GP practices to register inclusion health patients. These programmes were developed to support mostly migrants, are resource intensive and have never been systematically evaluated. To support inclusion health groups more broadly, there is a need to re-develop the current DOTW programmes in collaboration with F&T. Aims: The aim is to improve national access to primary care through GP registration for inclusion health groups. Development work plan: The programme will develop and test two programmes: first, a tool to help inform service users on their rights to primary care and empower them with knowledge to help them register with a GP practice; second, a training programme to train GP practice staff on the entitlements, specific health needs and how to register inclusion health patients around the UK. Patient and public involvement: Our programme has been informed by our extensive work with DOTW and F&T service users. We will invite two experts by experience from the DOTW advisory board to sit on the Advisory board for this study, attend project meetings, and support with publicly sharing the findings. We will also hold two experts by experience sessions with them to develop both programmes prior to the wider workshops. During the study we will hold a series of larger workshops where we will invite wider groups of people with lived experience to collaboratively design the two programmes. Outcomes and Impact: This programme will empower inclusion health service users to register for the GP and train GP staff on how to best support them. This will greatly benefit the patients ability to access timely, preventative health interventions and will result in direct savings to the NHS by reducing usage of expensive emergency care facilities.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE