About the RCGP's upcoming Fairer Practice Toolkit

I chair the RCGP’s Health Equity Special Interest Group. Today, I want to tell you about the RCGP’s Fairer Practice Toolkit, the development of which I am proud to lead. 

Health inequalities are one of the RCGP’s current priorities, and general practice is vital in reducing health inequalities. However, it can be challenging for practices and GPs to know what steps to take and what actions will make a difference.

About health inequalities

Health inequalities are unfair and avoidable differences in health across the population and between different groups in society. They arise because of the conditions in which we are born, grow, live, work and age. They may include, for example:

• availability of local services;
• language barriers;
• misinformation;
• access to childcare.

In many instances, clear social inequalities underlie health inequalities, and as GPs we feel helpless to change much unless the determinants of inequalities are changed. While that is true, there are still many things we can do for our patients – for example, if we know which of our patients are particularly disadvantaged, we can target appropriate services towards them, or act as their advocates in many of our external dealings with PCNs, Clusters, ICBs and Health Boards. There is also much we can do to address health inequalities at our own practice levels to ensure disadvantaged patients get a better deal from the NHS and our services.

What practices can do to address inequalities

Over the past year, we have worked hard to generate excellent content for the RCGP’s Health Inequalities Hub. This hub now includes four eLearning modules, a "10 in 10" resource, and various podcasts, webinars, and conference recordings. 

All these resources are designed to offer practical steps that GPs and their teams can take to tackle health inequalities. There’s a lot of great content, but it can still leave GPs and practices thinking, "Okay, but what can we actually do?"

I work as a GP in a practice in an area of significant socio-economic deprivation. Over the years, we’ve taken some actions to try and address inequalities. 

• All our patients who live in the most deprived 20% of postcode areas – our focus patients - are identified by a flag on their record, and a template guides health equity practice.
• Quality improvement work identifies trans patients who require cancer screening.
• We are a ‘safer surgery’ and veteran-friendly practice.
• We host a Citizen’s Advice advisor.

But we want to do more, and aren’t sure what to do next. I hope this is where the toolkit will help, because it aims to:

• Guide GPs and their teams in actions they can take to reduce health inequalities.
• Enable practices to demonstrate their commitment to health equity to their patients and the wider system. 
• Potentially act as a framework for additional investment in general practice.

How the toolkit will work

We aim to inspire and motivate people to address health inequalities through an aspirational, process-focused approach rather than an outcome-driven one. The toolkit will complement, not detract from, advocacy for proportionate universalism and fairer funding for general practice. It will focus on realistic, achievable, and, where possible, evidence-informed interventions while building on existing work and resources, including:

• Core20 PLUS
• the Scottish Government’s Inclusion Health Action in General Practice programme
• FAIRSTEPS and EQUALISE research
• Safe Surgeries
• Veteran Friendly Practices
• the Inclusion Health Self-Assessment Tool
• the Green Impact for Health Toolkit

Similar toolkits have proven successful in driving engagement and impact. To date, 1,151 practices have participated in the Green Impact for Health Toolkit, collectively completing over 290,000 sustainable healthcare actions. Toolkits like these are effective because they provide structured, actionable steps, enable us to measure progress, foster motivation, and can include elements of incentivisation. They can also help us share learning and processes across practices and regions, as we will all be following the same, or similar steps.

The Fairer Practice Toolkit will provide simple, actionable steps for busy GPs and colleagues to take and help change agents in practices to overcome blockers and barriers where present. We may offer tiered awards, for example bronze, silver and gold, which can motivate people. Such awards can help demonstrate to patients and the wider community a practice’s commitment to health equity and help patients to understand the values and ethos of the practice, including the provision of inclusive, equitable care.

The design of the toolkit

We have just launched a survey to gather a wide range of views on the toolkit’s principles, approach and content. You can complete the survey by visiting the RCGP health equity forum (member login needed).  

• We want to build on existing evidence for what is feasible and impactful in general practice, so we will use findings from the FAIRSTEPS and EQUALISE studies.
• In February, we are hosting an online roundtable event to engage with a wide range of stakeholders, including representatives from Deep End GP and charities.

After this, our working group will take the survey results and roundtable outputs and draft the first version of the toolkit, before refining this over the coming months, and launching it later this year.

Get involved

We would love your help in shaping and leading this work. Please join the Health Equity Special Interest Group and get involved!