'Bridging Gaps'- use of a coproduction approach to improve experiences accessing primary care for women with complex needs
Women with complex needs, such as addiction, homelessness, and domestic and sexual violence, experience extreme health and social inequality and have low engagement with mainstream health services. There is little existing research on effective interventions to target these issues, and research has thus far been led by the agendas of commissioners, clinicians and researchers rather than those of women with complex needs themselves.
InterventionThe project was developed through collaboration between women with complex needs, clinicians, and academics using a coproduction approach. Dr Lucy Potter is an academic GP working at a specialist health and welfare organisation for women with complex needs. Women using this service felt that it would be helpful to ‘ come together’ to discuss their experiences of accessing mainstream healthcare and how these could be improved. This led to creation of a peer advocacy group of 10 women with complex needs. Along with Dr Potter, Dr Lesley Wye was invited to participate in the group, bringing expertise in coproduction and health services research. Preliminary groupwork involved women meeting with ‘friendly’ GPs and commissioners to learn more about health services. The group also shared their experiences of accessing GP care, which involved being treated in a ‘prejudiced’ and ‘judgmental’ way. They decided to tackle this by developing and delivering interactive educational sessions for GPs and GP receptionists in a project titled ‘Bridging Gaps’. Sessions aim to develop mutual understanding and foster more positive interactions between primary care providers and women with complex needs. The group will also produce a training video for health and social care professionals. Support in development of these interventions is currently being provided through ’storytelling workshops’ delivered by Clare Murphy, a professional storyteller with experience of working with excluded groups. EvaluationEthnographic observation of groupwork (including the storytelling workshops), and the educational sessions in primary care will be carried out by an evaluation team consisting of Dr Helen Cramer and Dr Michelle Farr (experts in qualitative health and social science research), and Dr Helen McGeown, a GP Academic Clinical Fellow. Interviews will be held with women in the group and GP staff receiving the educational sessions. Findings will feed into a ‘social impact framework’ , to capture changes arising from co-production in terms of the impact on individuals, groups and organisations.
The women have thus far developed their understanding of health services, their confidence in sharing their stories, and their sense of agency in creating change.
We hope that use of the social impact framework will demonstrate the value of a coproduction approach as a way to meaningfully involve service users as drivers of multi-level change. This ranges from individual empowerment to potential whole systems change, and improved equity of primary healthcare provision.