Using GP Fellowships to support Health Equity project implementation in Primary Care: the Newham Case Study.

Problem

Health Equity aims to address differences in health that are unnecessary, avoidable, unfair, and unjust. Climate can also been conceptualised as an health equity issue, with evidence of environmental racism and poor climate impacting on health.

The London borough of Newham falls within the top five most deprived boroughs within the city according to the most recent rankings, with local population health data demonstrating poorer than average health outcomes across the life course in the Newham population.

Primary care has been identified as particularly well placed to support health equity. It has population coverage, direct contact with patients, potential for continuity, and offers comprehensive coordination of generalist care to patients in their own environment.

Educational Fellowships are an opportunity to “do something exceptional” and develop both knowledge and leadership skills. The local ICS made funding provision for Health Equity GP Fellows in its locality, with the aims of promoting workforce retention and developing local health equity projects and education resources.

Approach

The Newham Training Hub used this funding to recruit four local mid-career GPs as Health Equity Fellows for one session per week for a year under a Fellowship Scheme.

Each Fellow identified a local health equity issue to focus upon, developing their own knowledge, implementing a change in practice at local level and disseminating knowledge via educational resources.

The Fellows met monthly online to share progress and provide mutual support. These meetings were also attended by Training Hub representatives.

An anonymous survey with qualitative and quantitative measures was completed by Fellows near the end of their year.

Findings

All objectives for the scheme were either fully or partially met over the time period. At one year, three of the four GPs remained in a substantive role in the borough, all had implemented (or were in process of implementing) a local change in practice, and all had disseminated education on their chosen health equity topic to the local workforce.

A survey of the Fellows found that the scheme allowed protected time for local GPs already interested in health equity to develop their knowledge and produce learning material for their peers, and supported a degree of implementing local change while also acknowledging that “change takes time”. Building connections with like-minded professionals was a particular strength of the scheme, and the monthly Fellows peer meet-up was well received.

Formalising expectations of the Fellowship scheme, and planning for long-term implementation of projects started by the Fellows, were recommendations made in the survey, as well as developing a specific learning set in leadership.

Consequences

The GP Fellows scheme provided time and resources to develop projects and professional learning in Health Equity within Newham. A toolkit was developed by outgoing Fellows for future iterations of the scheme.