Fairer Practice Toolkit

Course: Fairer Practice Toolkit | RCGP Learning

• Understanding the Fairer Practice Toolkit (Module)
• An overview of the Fairer Practice Toolkit (Screencast)
• Understanding the Fairer Practice Themes (Screencast)
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• Foundation Actions

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  Theme	Action Code	Action Descriptor	Supporting Information	Supporting Resources
  Access and Flexibility	ACC_01	Inclusive registration Follow NHS registration guidelines by removing documentation barriers. Ensure patients can register for care without the need for ID or proof of address.	Many vulnerable patients face unnecessary barriers when trying to register with GP practices, even though NHS policy clearly states that no proof of address, ID, or immigration status is needed. This action helps ensure your practice provides welcoming, accessible registration for everyone in your community. Approaches to implementation: - Train reception and administrative staff on inclusive registration practices and NHS guidelines - Update registration forms and processes to remove requests for unnecessary documentation - Display welcoming signage in multiple languages stating that no proof of address or ID is needed - Conduct periodic checks and reviews of registration processes to identify any remaining barriers - Create a simple reference guide for staff outlining  registration practices Key benefits: Creates a more welcoming environment for vulnerable patients, helps staff feel confident about registration guidelines, and ensures everyone in your community can access the healthcare they need.	Healthwatch BMA guidance on patient registration  NHSE guidance  Scottish Guidance
  Health Needs Assessment	HNA_01	Identify and Define a Focus Patient Group Use local health needs data, deprivation data, and insights from patients and your team to identify and define your focus patient group (those most likely to experience poorer access, outcomes, or engagement).	Defining your Focus Patient group is a foundational step that shapes all other equity work in your practice. This locally-defined group represents those most at risk of poor access, missed care, and worse health outcomes in your specific context. Approaches to implementation: - Analyse practice data to identify groups with poor health outcomes or low engagement rates - Review local public health data on health inequalities and deprivation indices - Facilitate team discussions about which patients face the greatest barriers to care - Consult with community organisations and your Patient Participation Group - Document your chosen Focus Patient group with clear rationale and measurable characteristics Key benefits: Creates a clear framework for targeted interventions and ensures efforts address real local needs rather than assumptions.	WALES
  Team Wellbeing	WELL_01	Regular Staff Wellbeing Check-Ins Implement regular, structured check-ins within teams to discuss workload pressures, emotional challenges, and identify support needs early.	Schedule regular team wellbeing check-ins to support staff mental health. Create structured opportunities for team members to discuss workload pressures, share concerns, and access support before stress escalates into burnout. Healthcare staff experiencing stress or burnout may find it harder to provide optimal care, particularly to patients with complex needs. Regular wellbeing check-ins help create a culture where staff feel valued and supported. Implementation approach: - Hold weekly team huddles focused on wellbeing, not just clinical updates - Designate time in team meetings for staff to raise concerns without judgment - Establish informal buddy systems for peer support between formal check-ins - Train team leaders to recognise early signs of stress and burnout - Rotate demanding responsibilities to prevent individual overload Maintains staff resilience and capacity to provide compassionate care, reduces turnover and absence, and creates a supportive culture that models the wellbeing practices promoted to patients.
  Access and Flexibility	ACC_02	Safe Surgeries Accreditation Implement the Doctors of the World Safe Surgeries Toolkit to create an environment where all patients, regardless of immigration status, feel safe accessing healthcare.	The Safe Surgeries initiative helps practices create an environment where all patients, regardless of immigration status, feel safe accessing healthcare. Implementing this toolkit demonstrates your commitment to providing healthcare as a human right. Approaches to implementation: - Review the Doctors of the World Safe Surgeries Toolkit and assess current practice - Engage all staff in understanding why safe access matters for community health - Adapt toolkit recommendations to fit your specific practice context and population - Display Safe Surgeries certification and materials prominently in the practice - Monitor and share examples of how the initiative improves patient access Key benefits: Builds trust with marginalised communities who may fear accessing healthcare and ensures everyone can access care when needed. Positions your practice as a leader in inclusive healthcare.	Safe surgeries
  Values and Behaviours	VAL_00	Identify a Fairer Practice Lead	Having a designated Fairer Practice Lead is essential for embedding health equity into your practice. This person doesn't need to do all the work themselves, but they provide focus, accountability, and coordination for your efforts. The Lead can be a GP partner, salaried or session GP, practice manager, nurse, or any member of the wider team with protected time and visible support from practice leadership. Approaches to implementation: - Identify a team member with interest and capacity to champion health equity work and lead on Fairer Practice - Ensure the role has protected time allocated (even if minimal initially) - Connect the Fairer Practice Lead with the RCGP's Fairer Practice Community - Clarify the Fairer Practice Lead's remit, such as coordinating equity actions, liaising with external partners, and keeping the team informed - Announce the Fairer Practice Lead to the whole practice team and communicate their role clearly - Include the Fairer Practice Lead in relevant meetings and decision-making about practice development - Consider linking with other Fairer Practice Leads locally or regionally for peer support Key benefits: Provides clear accountability and coordination for equity work, ensures actions don't get lost among competing priorities, creates a visible commitment to health equity for staff and patients, and establishes a point of contact for the RCGP, system partners and community organisations.	RCGP Health Equity SIG RCGP Health Inequalities Policy RCGP eLearning resource RCGP Health Equity Forum

• Engaging Actions

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  Theme	Action Code	Action Descriptor	Supporting Information	Supporting Resources
  Access and Flexibility	ACC_03	Flexible appointment booking Ensure multiple access routes for booking appointments, including walk-in, phone, and digital options.	Digital-only booking systems can exclude patients with limited digital access, literacy challenges, or complex needs. Offering multiple booking options ensures all patients can access care in ways that work for them. Approaches to implementation: - Maintain telephone, online, and in-person booking options - Reserve a meaningful proportion of appointments for same-day telephone and walk-in bookings - Monitor booking patterns by method to ensure each pathway offers genuine access - Consider protected appointment slots for patients with accessibility needs Key benefits: Reduces health inequalities by ensuring patients facing digital exclusion, language barriers, or complex circumstances can still access timely care through their preferred booking method.	Safe surgeries BJGP What works: Mitigating inequalities in telephone and digital triage for primary health care
  Access and Flexibility	ACC_04	Offer Face-to-Face Appointments Upon Request Provide in-person consultations for patients who request or would benefit from them.	While remote consultations offer convenience for many, some patients have clinical, communication, or personal needs that make face-to-face appointments desirable or essential. Maintaining this option ensures equitable care for all patients. Approaches to implementation: - Ensure face-to-face slots are available - Establish clear processes for patients to request face-to-face appointments - Train staff to offer, or recognise when patients would benefit from, face-to-face consultations - Clearly communicate that face-to-face appointments remain available when needed Key benefits: Ensures patients with complex needs, communication barriers, or technology challenges receive appropriate care, maintaining trust and therapeutic relationships.
  Access and Flexibility	ACC_05	Facilitate Temporary Patient Registrations Enable individuals residing in the area for more than 24 hours but less than three months to register as temporary patients, particularly supporting those experiencing homelessness or in insecure housing.	Temporary registration is vital for marginalised and vulnerable groups who may struggle to access continuous healthcare, including people experiencing homelessness, survivors of domestic abuse in temporary accommodation, seasonal workers, refugees, people seeking asylum, and Gypsy, Roma, and Traveller communities. Without this option, many are forced to rely on urgent or emergency care, exacerbating health inequalities and worsening chronic conditions. Approaches to implementation: - Train all staff on temporary registration rights and procedures - Proactively offer temporary registration to eligible patients rather than turning them away - Ensure temporary patients receive the same quality of care as permanent patients - Monitor temporary registrations to identify patterns and improve processes Key benefits: Provides essential healthcare access to mobile and vulnerably housed populations, prevents minor health issues escalating to emergencies, and fulfils the practice's duty to provide care based on clinical need.	Healthwatch MA guidance on patient registration NHSE guidance
  Access and Flexibility	ACC_06	Multi-lingual registration information Ensure signage, registration information and online details are accessible in multiple languages spoken by your practice population.	Language barriers prevent many patients from understanding their rights to register and access care. Providing information in community languages demonstrates commitment to serving all residents equally. Approaches to implementation: - Identify the main languages spoken in your practice population - Translate key registration information and signage into these languages - Ensure translations are professional and culturally appropriate - Place multilingual signage prominently at entrances and reception areas - Include translated information on practice websites and printed materials Key benefits: Removes language as a barrier to healthcare access, helps patients understand their rights and how to access services, and creates a welcoming environment for diverse communities.	The NHS has produced a guide to the NHS for vulnerable migrants, available in multiple languages. Doctors of the World offers health information in multiple languages, which can be utilized for patient education and practice materials. What works to improve health and digital literacy in disadvantaged groups.
  Access and Flexibility	ACC_07	Staff training on access barriers Educate staff on the impact of digital exclusion, literacy issues, and cultural barriers.	Staff awareness of access barriers helps create a more inclusive service. Understanding how digital exclusion, literacy challenges, and cultural differences impact healthcare access enables staff to provide appropriate support. Approaches to implementation: - Provide induction and regular training sessions on different types of access barriers - Involve patients and iclude patient stories and local examples to make barriers real and relatable - Teach practical skills for identifying and addressing barriers in daily work - Create reference resources summarising key barriers and solutions - Encourage staff to share experiences and learning about overcoming barriers Key benefits: Builds staff confidence in supporting all patients regardless of their challenges and reduces discrimination.	Safe surgeries training sessions are available  What works: Empowering health care staff to address health inequalities
  Access and Flexibility	ACC_08	Recording Language Needs and Interpreter Requirement Routinely code patients' preferred spoken language and interpreter requirements to ensure consistent communication support at every interaction.	Accurate recording of language needs ensures patients receive appropriate communication support at every interaction. This systematic approach prevents language barriers compromising quality of care or patient safety. Approaches to implementation: - Update registration processes to capture preferred language and interpreter needs - Train staff on the importance of accurate language coding for patient safety - Create prompts in clinical systems to check and update language information - Establish clear processes for booking interpreters based on recorded needs - Regularly audit language data completeness and accuracy Key benefits: Improves patient safety by ensuring consistent communication support, enables better planning of interpreter services, and demonstrates organisational commitment to overcoming language barriers in healthcare.	Deep End Report on Landuage and Cultural Health Inequalities at the Deep End
  Advocacy and Policy	ADV_01	Local Advocacy Networks Facilitate networking opportunities, including Deep End GP groups, for GPs interested in advocacy for health equity to connect, share ideas, and collaborate.	Working in isolation limits our ability to address the structural factors that drive health inequalities. Local advocacy networks, including Deep End groups, provide vital peer support and collective voice for practices serving communities with high levels of deprivation. Approaches to implementation: - Connect with existing Deep End groups or health equity networks in your area - If none exist, reach out to neighbouring practices serving similar populations to gauge interest - Schedule regular meetings focused on sharing challenges and solutions and mutual support - Invite speakers from public health, community organisations, and policy roles - Document and share examples of successful advocacy to inspire continued action Key benefits: Creates collective power to influence local health systems, reduces professional isolation, and accelerates learning through shared experiences of what works.	University of Glasgow - The Scottish Deep End Project
  Care for Focus Patients	CARE_01	Understand the Health and Care of Your Focus Patients Use practice data to identify where your Focus Patient group is underrepresented in key clinical services or experiencing poorer outcomes.	Understanding how your Focus Patient group engages with key clinical services reveals hidden inequalities in care delivery. This mapping exercise transforms general concerns about equity into specific, actionable clinical improvements. Approaches to implementation: - Extract data showing uptake of key services (screening, immunisations, chronic disease reviews) by your Focus Patient group - Compare rates with practice averages to identify significant gaps - Investigate reasons for lower engagement through staff discussions and patient feedback - Prioritise 2-3 clinical areas where inequalities are most pronounced - Set specific improvement targets for Focus Patient engagement in these areas Key benefits: Moves from assumption to evidence about where clinical inequalities exist, enables targeted quality improvement, and demonstrates commitment to proportionate universalism in clinical care.
  Care for Focus Patients	CARE_02	Implement Targeted Blood Pressure and Cardiovascular Risk Checks Offer opportunistic or outreach-based BP checks and CVD risk assessments to patients known to be under-screened or facing disadvantage.	Cardiovascular disease disproportionately affects Focus Patients, yet these same groups often don't engage with routine screening and care opportunties. Targeted approaches help close this gap. Approaches to implementation: - Identify Focus Patients without recent BP recordings or CVD risk assessments - Offer opportunistic checks during any consultation, not just dedicated appointments and consider templates and popups to facilitate this - Partner with pharmacies and community venues (faith centres, foodbanks, homeless services) for outreach - Consider utilising machines in reception areas to provide open access to BP chescks Key benefits: Demonstrates that the practice actively seeks out those who might otherwise be missed, and builds trust through meeting people where they are.	What works: Improving case finding of long-term health problems in disadvantaged communities What works: Achieving equitable lipid management
  Care for Focus Patients	CARE_03	Improve Equity in Vaccination Uptake Through Targeted Recall and Support Identify patients from your Focus Patient group with missed vaccinations and offer accessible, supported options for catch-up.	Vaccination inequalities mirror wider health inequalities, with Focus Patient groups often having lower uptake due to access barriers, mistrust, or competing priorities. Approaches to implementation: - Run searches to identify where Focus Patients, including children, are missing vaccinations - Contact patients through their preferred communication method, not just standard letters - Offer flexible vaccination clinics at accessible times and locations - Work with trusted communities groups and venues - Address specific concerns or myths prevalent in your Focus Patient communities Key benefits: Protects the most vulnerable from preventable diseases, reduces community transmission in areas of high deprivation, and builds confidence in healthcare through responsive, culturally appropriate approaches.	What works: Addressing inequalities in the uptake of cervical screening
  Care for Focus Patients	CARE_04	Ensure Annual Physical Health Checks for patients with Severe Mental Illness (SMI) Use proactive recall to ensure all Focus Patients with SMI are invited to annual health checks and supported to attend.	People with SMI die 15-20 years earlier than average, largely from preventable physical conditions. When SMI intersects with other vulnerabilities in your Focus Patient group, these inequalities compound. Approaches to implementation: - Identify all Focus Patients on the SMI register and review their health check status - Implement assertive outreach for those who are not attending reviews - Offer flexible appointments including home visits where appropriate - Ensure health checks address the full range of physical health needs - Coordinate with mental health teams to provide joined-up support Key benefits: Addresses the mortality gap for people with SMI, demonstrates parity of esteem between mental and physical health, and shows the most marginalised patients with SMI that their physical health matters and they are cared for.	What works: Health checks for patients with severe mental illness
  Care for Focus Patients	CARE_05	Identify and Proactively Support Patients with a Learning Disability Ensure your practice has a robust process to identify, record, and maintain a register of patients with a learning disability, using appropriate clinical coding and enabling targeted support and reasonable adjustments.	People with a learning disability are often unrecognised in primary care. Proactively identifying and recording these patients, using clinical system codes and screening tools, enables practices to offer tailored support, reasonable adjustments, and proactive care planning. A complete and up-to-date register is the foundation for improving outcomes and reducing inequalities.	Learning Disability Register Inclusion Tool
  Care for Focus Patients	CARE_06	Ensure Inclusive Screening for Trans Patients Identify and invite all eligible trans and non-binary patients for appropriate cancer and health screening, regardless of gender marker.	Trans and non-binary patients often miss vital screening due to administrative systems based on binary gender markers, leading to preventable cancer risks for an already marginalised group. Approaches to implementation: - Review how gender is recorded and ensure systems capture both biological sex and gender identity - Create failsafe processes to ensure trans patients receive all appropriate screening invitations - Train staff on respectful communication about screening for trans patients - Develop clear protocols for which screening programmes apply based on sex and gender identity - Ensure screening environments and processes are welcoming and affirming Key benefits: Prevents cancer deaths in trans communities through appropriate screening and demonstrates visible inclusion and respect for gender diversity.	PHE - Seeing and hearing inclusivity PHE - Making screening more inclusive
  Care for Focus Patients	CARE_07	Improve Access for Gypsy, Roma and Traveller Communities Identify, record, and proactively address barriers to care for Gypsy, Roma and Traveller patients.	Gypsy, Roma and Traveller communities experience some of the starkest health inequalities of any ethnic group in the UK, yet are often invisible in health data. Proactive outreach and cultural understanding are essential. Approaches to implementation: - Ensure ethnicity recording includes specific categories for Gypsy, Roma and Traveller people - Build relationships with local Traveller sites and community advocates - Offer flexible registration that accommodates diverse lifestyles - Provide hand-held records to support continuity across different services - Address discrimination by ensuring zero-tolerance policies explicitly include anti-Gypsy, Roma and Traveller prejudice Key benefits: Begins to address the severe health inequalities experienced by Gypsy, Roma and Traveller communities, builds trust with groups who have experienced healthcare discrimination, and improves health data to make inequalities visible.	FRIENDS, FAMILIES & TRAVELLERS - Resources for healthcare professionals FRIENDS, FAMILIES & TRAVELLERS - Inclusive services training
  Care for Focus Patients	CARE_08	Assess the Needs of Vulnerable Migrants Use NHS bilingual health needs questionnaires to assess the health and support needs of newly registered vulnerable migrants at or soon after registration.	Vulnerable migrants often arrive with complex health needs, trauma histories, and limited understanding of NHS services. Early comprehensive assessment enables appropriate support. Approaches to implementation: - Implement bilingual health assessment questionnaires at registration - Train staff to sensitively explore health needs, including infectious diseases and trauma - Establish clear pathways for common issues (TB screening, maternal health, trauma rehabilitation) - Link with local migrant support organisations for wraparound care - Ensure interpretation is readily available for these crucial early consultations Key benefits: Identifies health needs early before they become emergencies, helps vulnerable migrants understand and navigate NHS services, and demonstrates that the practice provides sanctuary and comprehensive care.	NHS England
  Continuity of Care	CONT_01	Measure and Discuss Continuity of Care in the Practice Team Track and review continuity of care metrics, particularly for Focus Patients, to identify and address fragmented care patterns.	Continuity of care benefits  Focus Patients, particularly those with complex needs, mental health conditions, and who have experienced trauma. Measuring continuity helps identify where relationship-based care is breaking down. Approaches to implementation: - Calculate continuity indices for different patient groups, with focus on your Focus Patients - Share data in team meetings to raise awareness of current continuity levels - Identify specific groups or individuals with who would benefit most from enhanced continuity - Discuss practical barriers to continuity and develop team solutions - Set improvement targets specifically for Focus Patient continuity Key benefits: Makes invisible patterns of fragmented care visible to the whole team, enables targeted improvements for those who most need relational continuity, and reinforces the value of therapeutic relationships.	RCGP - Continuity of care The Health Foundation
  Continuity of Care	CONT_02	Ensure Patients Can See Their Named GP When Possible Enable patients to request and book appointments with their preferred GP to support continuity.	Continuity of care improves health outcomes, particularly for patients with complex needs, mental health conditions, or those who have experienced trauma. Enabling patients to see their preferred GP builds therapeutic relationships essential for effective care. Approaches to implementation: - Reserve some slots specifically for continuity appointments with regular patients - Allow GPs to book patients for follow-up to enable continuity (See CONT_03) - Train reception staff to ask patients if they have a preference and accommodate where possible - Monitor which Focus Patients repeatedly request specific GPs and proactively facilitate this - Balance continuity with timely access by offering choice: "see preferred GP in 3 days or any GP today" Key benefits: Strengthens therapeutic relationships that improve health outcomes, reduces repeated explanations of complex and/or traumatic histories, and demonstrates that the practice values patient preferences and relationship-based care.
  Continuity of Care	CONT_03	Facilitate Follow-Up Appointments for Patients and Clinicians Ensure appointment systems allow follow-ups to be booked at the point of care, rather than requiring patients to call back later.	Requiring patients to call back for follow-up appointments creates barriers, particularly for those with communication difficulties, complext lives, or limited access to phone or digital services. Direct booking ensures continuity and reduces missed follow-ups. Approaches to implementation: - Enable clinicians to book follow-ups directly during consultations - Ensure booking systems have sufficient forward visibility for appropriate follow-up intervals - Create protected follow-up slots that can't be released to routine booking - Remove administrative barriers that prevent point-of-care booking - Address digital barriers by maintaining non-digital booking options for follow-ups - Use reminder systems to minimise the risk of patients not attending follow-up Key benefits: Reduces barriers for vulnerable patients who struggle with phone systems and improves continuity by allowing appropriate follow-up.
  Digital Inclusion	DIG_01	Proactively Identify Digitally Excluded Patients Use practice data to identify patients who are digitally excluded and ensure they have alternative access options clearly recorded.	Digital exclusion compounds health inequalities, yet those most likely to be digitally excluded are often invisible in our systems. Proactively identifying these patients enables digital services to enhance rather than hinder access to care. Approaches to implementation: - Search for groups likely to be digitally excluded (see supporting resources) - Analyse appointment bookings to identify patients who never use online services - Cross-reference with deprivation indices and age data to find likely digitally excluded groups - Add markers to patient records indicating preference or need for non-digital communication - Ensure all digital services have accessible non-digital alternatives - Train reception staff to sensitively recognise and support digitally excluded patients Key benefits: Prevents digital services from widening health inequalities, ensures no patient is left behind by digital transformation, and maintains trust with communities who may feel excluded by technology.	NHS England - Digital Inclusion Good Things Foundation Health Equity Evidence Centre
  Digital Inclusion	DIG_02	Embed Digital Inclusion in Staff Training Incorporate digital inclusion awareness into staff training, helping teams recognise and support digitally excluded patients without assumptions.	Staff may not recognise how digital exclusion affects health access or may inadvertently create barriers through assumptions about digital capability. Training helps teams provide genuinely inclusive services. Approaches to implementation: - Include digital inclusion in staff induction and training programmes - Make staff aware of digital exclusion rates in your practice population - Teach practical skills for supporting patients with digital tasks to support access and healthcare - Challenge assumptions about who is digitally excluded (not just older patients) - Create quick reference guides for non-digital alternatives to all services Key benefits: Builds a digitally inclusive culture where all staff understand their role in preventing digital exclusion, reduces unintentional discrimination, and ensures consistent support across the team.	NHS England - Digital Inclusion Good Things Foundation Health Equity Evidence Centre
  Health Literacy and Education	HLIT_01	Provide Multilingual, Accessible NHS Navigation Guides at Registration Ensure that practice websites, printed materials, and patient education tools are available in clear, simple formats and common community languages, helping all patients understand their rights and how to access care.	Understanding how to navigate NHS services can be challenging, regardless of English proficiency. Providing accessible guides in multiple languages ensures all patients can access the care they're entitled to. Approaches to implementation: - Identify the main languages spoken in your practice population - Create or source NHS navigation guides in these languages - Include easy-read versions with pictures for patients with a learning disability - Ensure guides explain patients' rights, how to book appointments, and when to seek help - Make guides available in print, online, and through community partners Key benefits: Empowers patients to navigate healthcare independently, reduces pressure on reception staff to explain basic processes repeatedly, and demonstrates commitment to serving diverse communities equitably.	Deep End Report
  Health Literacy and Education	HLIT_02	Integrate Health Literacy Training into Staff Development Include health literacy training in induction and ongoing professional development for all practice staff to ensure effective communication strategies.	Low health literacy affects 43% of working-age adults in England. Training staff to recognise and respond to health literacy needs improves communication, safety, and outcomes for vulnerable patients. Approaches to implementation: - Provide foundational training on health literacy for all patient-facing staff - Teach techniques like teach-back and chunk-and-check for clear communication - Practice explaining common conditions and treatments in plain language - Create a culture where checking understanding is routine - Share examples of how improved health literacy improves quality and patient safety Key benefits: Improves patient safety through better understanding of treatment plans, reduces inequalities by ensuring complex information doesn't exclude vulnerable patients, and builds staff confidence in clear communication.	Health Equity Evidence Centre NHS Engalnd - Improving health literacy
  Health Needs Assessment	HNA_02	Strengthen Links with Public Health Teams Engage with local public health colleagues to share data, collaborate on population health priorities, and align general practice services with community needs.	Public health teams hold valuable data and expertise about local health inequalities but are often disconnected from general practice. Building these relationships enhances your ability to address population health needs. Approaches to implementation: - Identify your local public health lead for primary care or health inequalities - Schedule regular meetings to share intelligence about emerging health needs - Access public health data tools and training opportunities for practice staff - Collaborate on targeted interventions for your Focus Patient groups - Contribute insights from your practice to inform local public health strategies Key benefits: Brings expertise and resources to support health equity work, ensures practice efforts align with wider population health strategies, and strengthens the practice's influence on local health policy.	Scotland Public Health Support BJGP Open
  Health Needs Assessment	HNA_03	Conduct a health needs assessment for your practice Assess and document the demographic makeup, key health needs, and inequalities within your practice population. Create a report summarising this.	A comprehensive health needs assessment provides the evidence base for all equity work. It transforms assumptions into data-driven insights about where to focus limited resources for maximum impact. Approaches to implementation: - Utilise the Fairer Practice Health Needs Assessment Tool to analyse practice health equity data - Identify gaps in screening, immunisation, and chronic disease management - Engage patients and community groups to understand unmet needs - Document findings in a clear report with actionable recommendations Key benefits: Provides robust evidence for funding applications and service development, ensures equity efforts address actual rather than perceived needs, and creates a baseline to measure improvement over time.	Scotland Public Health Support  Fingertips
  Addressing Missingness	MISS_01	Identify patients at high risk of missingness and explore barriers Track local patterns of missed care and use this information to explore root causes and inform tailored support.	Missed appointments and disengagement from care should trigger curiosity, not blame. Missingness is defined as the 'repeated tendency not to take up offers of care such that it has a negative impact on the person and their life chances'. Research shows patients missing more than two GP appointments per year have significantly higher premature death rates and are more likely to have multimorbidity, especially mental health conditions. 'Missingness' shifts focus from blaming patients for DNAs to understanding why some people repeatedly disengage from care and how healthcare systems need to adapt. Approaches to implementation: - Identify patients with repeated DNAs across primary and secondary care, not just GP appointments - Analyse patterns of missed appointments alongside patient demographics, conditions, and social factors - Make sensitive and emapthetic contact with patients to understand their specific barriers, avoiding judgement - Map common themes including transport, trauma, treatment burden, and experiences of discrimination - Develop tailored responses based on actual barriers rather than assumptions about 'non-compliance' Key benefits: Transforms DNAs from administrative problems into opportunities for addressing health inequalities, prevents premature mortality in vulnerable groups, and demonstrates that healthcare systems can adapt to meet all patients' needs effectively.	Missingness resources
  Multidisciplinary Team Approaches	MDT_01	Proactively Identify High-Need Patients for MDT Care Planning Use structured methods (e.g., SNOMED coding, deprivation indexes) to proactively identify Focus Patients who would benefit most from multidisciplinary care planning and implement MDT-led interventions.	Multidisciplinary team working is most effective when practices proactively identify and prioritise a sub-set of Focus Patients who have multiple intersecting needs. Patients with complex health and social needs often struggle with fragmented care across multiple services. Proactive identification ensures those who would most benefit from coordinated care receive it. Approaches to implementation: - Develop clear criteria combining clinical, social, and engagement factors - Use practice searches to identify patients meeting multiple complexity indicators - Include staff insights about patients struggling with current care arrangements - Prioritise patients where coordinated care could prevent crisis or admission - Ensure identification process captures Focus Patients who may be less visible Key benefits: Prevents complex patients from falling through gaps between services, reduces crisis presentations through proactive coordination, and ensures MDT resources are allocated based on need rather than demand.	London work on SNOMED codes - Aaminah Verity.
  Multidisciplinary Team Approaches	MDT_02	Structured MDT Meetings with Protected Time Establish regular, structured multidisciplinary team meetings with protected time to discuss and coordinate care for Focus Patients with complex needs.	Effective MDT meetings require structure, preparation, and genuine multidisciplinary input. Protected time signals that coordinating complex care is a practice priority, not an add-on to other work. Approaches to implementation: - Schedule regular MDT meetings - Circulate Focus Patient lists in advance - Create structured templates ensuring holistic assessment of needs - Include social care, mental health, and voluntary sector partners - Document clear actions with named responsibilities and review dates Key benefits: Improves outcomes through coordinated multi-agency responses, reduces duplication and gaps in care planning, and builds stronger working relationships across professional boundaries.	Govan SHIP Deep End Report
  Networks of Support	NET_01	Develop Practice-Level Community Resource Lists Develop and maintain comprehensive lists of local community, welfare and voluntary services to enable effective signposting for Focus Patients.	Comprehensive resource lists enable effective signposting and strengthen social prescribing for Focus Patients. Clear, regularly updated lists of local services (such as housing support, charities, welfare advice, employment assistance, and social prescribing initiatives) enable staff to effectively refer and connect patients to wider community resources, enhancing holistic care. Practices should recognise that staff often face significant stress and potential burnout from dealing with complex patient needs. Adequate training and support for staff on local resources can enhance their ability to effectively manage patient interactions. Administrative and reception staff play a critical frontline role in connecting patients to community resources. Approaches to implementation: - Map all local services relevant to your Focus Patient needs - Engage with other practices within your networks to build resource lists - Include practical details: referral routes, eligibility, waiting times, costs - Engage link workers and social prescribers to create and maintain the resource - Make lists easily accessible to all staff during consultations - Regular review to ensure information remains current and accurate Key benefits: Enables staff to confidently signpost to appropriate support, multiplies the practice's impact through community partnerships, and ensures Focus Patients access all available help beyond medical care.
  Minoritised Ethnic Communities	MIN_01	Identify Ethnic Minority Patients in the Practice Population Use practice systems and coding to identify patients from ethnically and racially minoritised groups to support equity-focused service planning and care delivery.	Accurate ethnicity recording makes health inequalities visible and enables targeted action. Without this data, significant disparities in care and outcomes remain hidden, preventing effective responses to ethnic health inequalities. Approaches to implementation: - Review completeness of current ethnicity data in practice systems - Implement respectful processes for collecting ethnicity data at registration and reviews - Use appropriate ethnicity categories that reflect your local population - Train staff on why ethnicity data matters for addressing health inequalities - Ensure data collection emphasises improving care, not surveillance Key benefits: Makes ethnic health inequalities visible and measurable, enables targeted quality improvement for groups experiencing poorer outcomes, and demonstrates commitment to addressing racism in healthcare.
  Minoritised Ethnic Communities	MIN_02	Use Ethnicity Data to Identify and Respond to Disparities in Access, Experience and Outcomes Review ethnicity-coded data to identify disparities and design specific actions to reduce inequities in access, experience, and health outcomes.	Data without action perpetuates inequalities. Analysing care by ethnicity reveals where minoritised communities access and receive different treatment, enabling targeted improvements to close these gaps. Approaches to implementation: - Analyse key clinical indicators by ethnicity (screening uptake, disease management, prescribing) - Where possible, compare practice patterns with local and national data on ethnic health inequalities - Engage affected communities to understand reasons behind identified disparities - Design specific interventions targeting the inequalities found - Monitor impact and adjust approaches based on what works Key benefits: Transforms concerns about racism into specific, measurable actions, ensures equal treatment becomes reality not just policy, and builds trust with minoritised communities through visible action.
  Minoritised Ethnic Communities	MIN_03	Introduce Basic Race and Health Awareness Training Provide foundational training to ensure all practice staff understand race, racism, anti-racism and racial and ethnic disparities in primary care experience and health outcomes.	Understanding how racism operates in healthcare is essential for addressing ethnic health inequalities. Training helps staff recognise and challenge both interpersonal and systemic racism affecting patient care. Approaches to implementation: - Provide mandatory training on racism and health for all staff roles - Include local data showing ethnic health inequalities in your practice area - Address unconscious bias while focusing on systemic and structural racism - Create safe spaces for staff to discuss and reflect on these challenging topics - Follow training with concrete actions to embed anti-racist practice Key benefits: Builds team capacity to recognise and address racism in healthcare, reduces discriminatory practices that harm patient care, and positions the practice as actively anti-racist rather than passively non-racist.
  Addressing Stigma and Discrimination	STIG_01	Foster Welcoming Practice Environments Create visibly inclusive environments through welcoming messaging, accessible resources, and staff training that signals all patients are valued and safe.	First impressions matter deeply for patients who have experienced discrimination. Creating visibly inclusive environments signals that all patients are valued, encouraging engagement from those who might otherwise avoid healthcare. Approaches to implementation: - Display inclusive imagery representing your diverse patient population - Ensure signage explicitly welcomes marginalised groups (LGBTQIA+, migrants, etc.) - Regular walk-throughs imagining the experience of different patient groups - Provide patient information in formats accessible to all - Train reception staff as champions of inclusive, welcoming behaviour Key benefits: Reduces anxiety for patients who fear discrimination, encourages early help-seeking from marginalised groups, and creates a practice culture where diversity is visibly celebrated and protected.	Doctors Of The World
  Structural Competence	STR_01	Introduce Basic Structural Competence Training Provide simple, accessible training sessions or briefings to enhance all practice staff’s understanding of how social structures affect patient health and interactions.	Structural competence helps staff understand how poverty, housing, immigration systems and other social structures create ill health. This shifts focus from individual behaviour to addressing the conditions that constrain patient choices. Approaches to implementation: - Start with practical examples of how social structures affect health in your area - Include both clinical and non-clinical staff in training sessions - Teach staff to ask "what's happening to you?" not just "what's wrong with you?" - Provide tools for documenting and responding to structural vulnerabilities - Link training to practical changes in practice systems and processes Key benefits: Reduces victim-blaming approaches that stigmatise and alienate vulnerable patients, improves ability of staff to address root causes not just symptoms, and positions the practice as understanding and responsive to social determinants of health.	Science Direct National Library of Medicine Health Equity Evidence Centre
  Team Education	EDU_01	Regular Protected Team Health Equity Education Time Establish dedicated, protected time for regular team education sessions explicitly addressing health inequalities and related issues.	Addressing health inequalities requires ongoing learning and reflection. Protected education time signals organisational commitment and ensures all team members develop the knowledge and skills needed for equity-focused care. Approaches to implementation: - Schedule regular protected learning time focused on health equity topics - Cover health equity topics in existing protected time for education and training - Involve the whole practice team and rotate session leadership to share different perspectives and expertise - Include patient voices and community organisations in education sessions - Link learning directly to practice improvement projects - Document and share learning to build collective knowledge Key benefits: Builds sustained team capacity for addressing health inequalities, creates shared values, language and understanding across all roles, and embeds equity as core to your business rather than an optional extra.	NHS Wales Education Directory
  Team Education	EDU_02	Neurodiversity awareness training Provide education and training for all staff on neurodiversity and neuroaffirmative approaches, co-designed with neurodivergent people.	Neurodivergent patients often face barriers in healthcare settings designed for neurotypical people. Team education can help staff feel more confident, reduce misunderstandings, and support better, more inclusive care for both patients and colleagues. Training helps staff provide affirming care that works with, rather than against, neurodivergent patients and staff. Approaches to implementation: - Deliver training co-designed with neurodivergent people and advocacy groups - Cover autism, ADHD, dyslexia, dyspraxia and other forms of neurodivergence through a neuroaffirmative lens - Teach practical frameworks like Autistic SPACE: Sensory adjustments, Predictability, Acceptance, Communication adaptations, and Empathy - Use education resources from Autistic Doctors International and neurodivergent-led organisations - Cover autism, ADHD, dyslexia, dyspraxia and other forms of neurodivergence - Focus on environmental modifications and flexible consultation approaches - Challenge deficit-based models by highlighting neurodivergent strengths and perspectives Key benefits: Improves healthcare experiences for neurodivergent patients and staff, reduces misunderstandings that lead to poor care, and creates more flexible, inclusive practice environments benefiting everyone.
  Team Wellbeing	WELL_02	Access to Occupational Health and Psychological Support Ensure equitable access for all practice staff (clinical and non-clinical) to occupational health and psychological support services.	Healthcare work takes a toll on mental health, particularly for staff from marginalised backgrounds or those supporting complex patients. Not all staff groups may access occupational health services equally. Equitable access to support protects staff wellbeing and sustains compassionate care. Approaches to implementation: - Audit current access to occupational health across all staff groups - Address gaps where non-clinical or part-time staff lack support - Ensure psychological support is culturally appropriate and accessible - Actively promote services to reduce stigma around seeking help Key benefits: Protects mental health of all team members regardless of role, reduces burnout and turnover in critical positions, and models the wellbeing support the practice promotes to patients.	England  Scotland - The Workforce Specialist Service (WSS) National Wellbeing Hub
  Team Wellbeing	WELL_03	Introduce Anonymous Staff Feedback Mechanisms Establish a double anonymous feedback system (e.g. digital form, secure comment box) to allow team members to voice concerns or improvement ideas without fear of retribution.	Psychological safety enables staff to raise concerns about discrimination, unsafe practices, or barriers to equitable care. Anonymous feedback mechanisms ensure all voices are heard, particularly those in less powerful positions. Approaches to implementation: - Implement truly anonymous feedback systems (digital tools or physical boxes) - Clearly communicate how feedback will be reviewed and acted upon - Share themes from feedback with the whole team while maintaining anonymity - Demonstrate concrete actions taken in response to feedback - Offer regular reminders that feedback is welcomed and valued Key benefits: Surfaces hidden problems affecting patient care and staff wellbeing, empowers staff in junior roles to contribute to practice improvement, and builds trust through transparent response to concerns.
  Trauma-Informed and Enabled Care	TIC_01	Basic Trauma-Informed Care Awareness Training Provide foundational training for all practice staff (clinical and non-clinical) to develop an understanding of trauma-informed principles and approaches.	Many patients experiencing health inequalities have trauma histories that affect their engagement with healthcare. Training all staff in trauma-informed approaches prevents re-traumatisation and builds therapeutic relationships. Approaches to implementation: - Deliver foundational training covering the prevalence and impact of trauma - Include all staff roles; everyone shapes the patient experience - Focus on practical skills: offering choices, explaining procedures, recognising triggers - Address vicarious trauma (see resources) and self-care for staff - Create trauma-informed policies for common practice procedures Key benefits: Reduces re-traumatisation of vulnerable patients in healthcare settings, improves engagement with patients who struggle to trust services, and creates safer environments for both patients and staff with trauma histories.	BMA
  Values and Behaviours	VAL_01	Promote Shared Discussion of Team Values Use regular team spaces to explore and reflect on the values that underpin how you work with each other and your patients.	Values drive behaviour, yet teams rarely discuss explicitly what matters most in their work. Regular values discussions create shared understanding, reinforce a shared sense of purpose, and support emotional safety and a commitment to equitable care, particularly important when supporting patients facing discrimination or disadvantage. Approaches to implementation: - Hold a values summit, where the whole practice team agrees on shared and mutual values that can support equitable care - Document key themes to build shared language and accountability over time - Use real scenarios to discuss how values translate into daily practice decisions - Include all staff roles in discussions - reception staff's values matter as much as clinicians' - Connect values discussions to specific improvements for Focus Patient care Key benefits: Creates team cohesion around equity goals, surfaces and resolves values conflicts that can undermine care, and builds collective commitment to serving marginalised patients with dignity and respect.
  Values and Behaviours	VAL_02	Develop and Display a Team Charter or Code of Conduct Co-create and display a short statement of your practice’s agreed values and behaviours.	A visible values charter translates abstract values into concrete commitments and acts as a reminder of the culture your team is striving to build. When created together with staff and patients, it supports shared ownership and reinforces positive behaviours. It also sends a clear message to patients about what they can expect and what is expected of them in return. Charters can guide decisions, shape recruitment and appraisal processes, and help resolve conflict in ways that are aligned with core principles. Approaches to implementation: - Facilitate inclusive workshops with staff, patients, and community representatives - Focus on specific behaviours that demonstrate values in action - Keep language simple and accessible - avoid healthcare jargon - Display prominently in waiting areas and staff spaces - Review annually to ensure the charter remains living and relevant Key benefits: Makes equity commitments visible and accountable to patients, guides behaviour in challenging situations, and demonstrates to marginalised communities that they can expect respectful, inclusive care.

  
  
  

• Achieving Action

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  Achieving

  Theme	Action Code	Action Descriptor	Supporting Information	Supporting Resources
  Access and Flexibility	ACC_09	Extended consultations for complex needs Offer longer appointments for Focus Patients who need or will benefit from this.	Standard 10-minute appointments often fail Focus Patients, particularly those with multiple conditions, communication needs, or trauma histories. Extended consultations provide time to address complex needs, preventing repeated visits for unresolved issues. Approaches to implementation: - Establish a system to identify Focus Patients who need more time due to complexity - Create systems for offering double or even triple appointments for identified patients - Train clinicians to use extended time therapeutically - Monitor impact on patient satisfaction and clinical outcomes - Protect extended slots from being used for routine care when demand is high Key benefits: Improves quality of care for patients with the greatest needs, reduces inequality by providing time proportionate to complexity, and often prevents more costly emergency care.	Building equitable care toolkit Inclusion Health Action in GP CARE Plus Study
  Access and Flexibility	ACC_10	Flexible appointment structures Move away from rigid early-morning booking rushes and offer a mix of pre-bookable, on-the-day, and walk-in slots	The traditional 8am phone rush excludes many vulnerable patients, including those in insecure work, with caring responsibilities, or experiencing mental health challenges. Drawing on the FAIRSTEPS framework, flexible appointment structures are a key intervention that makes services easier to access for underserved groups. Approaches to implementation: - Discuss your current appointment structures and how these might disadvantage Focus Patients - Maintain a genuine mix of advance, same-day, and walk-in options throughout the day - Reserve meaningful proportions of appointments for walk-in access, particularly for patients experiencing crisis - Ensure booking options work across the day, not concentrated in early morning rushes - Reserve specific slots for patients who might struggle with traditional appointment booking processes - Build in flexibility for staff to exercise judgement about urgent needs Key benefits: Removes structural barriers that exclude vulnerable patients from timely care, reduces the inequality of access based on ability to navigate systems, and demonstrates responsiveness to diverse patient needs.	Building equitable care toolkit
  Access and Flexibility	ACC_11	Interpretation availability at reception Ensure access to interpreters at reception e.g. to support appointment bookings and information requests.	Language barriers often begin at reception, preventing patients from booking appointments or understanding their care. Interpretation at first contact ensures equitable access from the moment patients engage with the practice. Approaches to implementation: - Set up telephone interpretation services that are accessible at reception - Train all reception staff to recognise language needs and access interpretation quickly - Display clear signage in multiple languages about interpretation availability - Monitor which languages are most needed and consider on-site interpreters for these - Include interpretation in reception protocols as standard, not exceptional, practice Key benefits: Removes language as a barrier to healthcare access from the very first interaction, prevents miscommunication that can lead to missed or inappropriate care, and demonstrates that all patients can expect to be understood.	Deep End Report
  Access and Flexibility	ACC_12	Care navigation training for reception teams Equip frontline staff to guide patients effectively to the right service.	Reception staff play a crucial role in directing patients to appropriate services. They are often the first point of contact but may lack training to navigate complex health and social care systems. Effective care navigation ensures vulnerable patients reach appropriate support quickly. Approaches to implementation: - Provide comprehensive training on local health, social care, and voluntary services (see NET_01) - Develop quick reference guides for common signposting scenarios - Include training on sensitive questioning to understand underlying needs - Create clear escalation routes when reception staff identify urgent concerns - Regular updates as services change to maintain accurate knowledge Key benefits: Transforms reception from gatekeeping to enabling appropriate access, reduces pressure on clinical staff by directing patients efficiently, and ensures vulnerable patients connect with the full range of support.	NHSE guidance
  Access and Flexibility	ACC_13	Enable proxy addresses Allow patients with no fixed address to use the practice as their postal address for essential correspondence.	Lack of a postal address creates cascading barriers, from receiving appointment letters to accessing benefits that support health. Providing a safe postal address removes a fundamental obstacle for patients experiencing homelessness or insecure housing. Approaches to implementation: - Train staff on the importance and sensitivity of this service and to proactively offer this at registration or other times - Establish clear protocols for patients to use the practice address - Create secure systems for storing and notifying patients about received post - Partner with homelessness services to ensure coordinated support - Monitor usage to understand the scale of housing insecurity in your patient population Key benefits: Enables access to essential services that require postal addresses, prevents health deterioration linked to missed communications, and provides dignity to patients experiencing homelessness.	CQC mythbuster Guidance in safe surgeries Toolkit
  Access and Flexibility	ACC_14	Named GP for Each Focus Patient Assign a consistent GP to patients with complex or high-risk needs to improve continuity of care.	Continuity of care particularly benefits Focus Patients, who may have experienced trauma or have complex conditions or mistrust of services. A named GP builds the therapeutic relationships essential for effective care. Approaches to implementation: - Systematically identify Focus Patients who would most benefit from continuity - Where possible, match patients with GPs based on skills, previous involved and rapport - Establish access and booking systems to facilitate named GPs to see their allocated patients - Create buddy arrangements for urgent issues when named GP unavailable - Monitor continuity rates as a quality indicator for Focus Patient care Key benefits: Builds trust with patients who have experienced discrimination or trauma, improves outcomes through relationship-based care, and reduces emergency presentations by providing consistent preventive care.	RCGP continuity of care toolkit. BJGP Open
  Access and Flexibility	ACC_15	Review ‘One Appointment, One Problem’ Policies Facilitate a practice discussion on the impact of ‘one appointment, one problem’ policies and consider flexibility for patients with complex needs.	Rigid 'one problem' policies particularly disadvantage patients with multimorbidity, communications difficulties, mental health conditions, or difficulty accessing services. Restricting consultations in this way may lead to missed diagnoses, fragmented care, and increased re-attendance rates, ultimately placing greater strain on the system. Flexibility recognises that some patients need more holistic care to address interconnected issues. Approaches to implementation: - Discuss as a practice the removal of your 'one appointment, one problem' policy, even if only for Focus Patients. - Facilitate team discussions on balancing access with comprehensive care - Support clinicians  to develop skills in holistically managing complex consultations - Offer opportunities for clinicians to discuss cases and how they are managing with the new system. Key benefits: Prevents fragmentation of care for complex patients, reduces multiple appointments for interconnected problems, and demonstrates understanding that health inequalities require proportionate responses.	RCGP continuity of care toolkit. BJGP Open
  Access and Flexibility	ACC_16	Neurodivergent-inclusive access and experience Proactively identify and address barriers to access for neurodivergent patients by creating practice environments and systems that are flexible, predictable, and accepting of different needs.	Healthcare environments designed for neurotypical patients can be overwhelming or inaccessible for neurodivergent people, inclusing autistic people and those with ADHD. Creating neuroaffirmative, neurodivergent-inclusive practices, using frameworks such as Autistic SPACE, improves access for an often invisible population. Approaches to implementation: - Sensory: Conduct environmental audits to identify and modify sensory barriers (lighting, noise, smells), creating a sensory map for the practice - Predictability: Provide clear, visual information about what to expect during visits and appointment processes - Acceptance: Create a culture that accepts stimming, different communication styles, and movement needs - Communication: Train staff in neuroaffirmative communication approaches. Offer multiple communication methods and adjust pace/style to individual preferences - Empathy: Train staff to understand neurodivergent experiences without making assumptions - Offer alternatives to busy waiting rooms (direct to room, wait in car with text alert). Offer adjustments like quiet waiting spaces, first/last appointments, or direct room access - Record and share individual adjustments that help specific patients Key benefits: Removes barriers that prevent neurodivergent patients accessing healthcare, reduces distress and shutdown during healthcare interactions, and creates more flexible environments that may benefit patients beyond those with diagnosed neurodivergence.	Autistic SPACE
  Access and Flexibility	ACC_17	Embed Reasonable Adjustments for People with a Disabilty, including a Learning Disability Commit to making reasonable adjustments for people a disability and ensure staff receive training on practical implementation.	Reasonable adjustments -- are essential for equitable care, and ongoing staff training builds understanding and confidence to meet legal and ethical duties. The Equality Act 2010 requires healthcare providers to make reasonable adjustments, yet many disabled patients still face barriers to equitable care. Embedding adjustments as routine practice rather than exceptional responses ensures disabled patients receive care that meets their needs. Approaches to implementation: - Train all staff on legal duties and practical examples of reasonable adjustments, for example longer appointments, easy-read materials, or flexible communication - Co-produce a practice statement on reasonable adjustments and display it for patients and staff - Include adjustment flags, for example NHS England’s Reasonable Adjustment Flag, or alerts in your clinical system - Create a practice register of adjustments for individual patients - Develop partnerships with patients with a disability and disability organisations for guidance and feedback Key benefits: Fulfils legal obligations whilst improving care quality for disabled patients, reduces health inequalities experienced by people with a disability, and creates a practice culture where adjustments are normalised rather than seen as special treatment.	NHSE - Reasonable Adjustment Flag
  Access and Flexibility	ACC_17	Proactively Flag Access Needs in the Clinical Record Identify and flag patients who need a different approach to access and care, ensuring adjustments are provided at every interaction.	Many patients have specific access needs that, when unrecognised, create repeated barriers to care. Proactive flagging ensures these needs are visible and addressed at every interaction, preventing patients from having to repeatedly advocate for accommodations and adjustments. This action is particularly helpful as a starting point for practices working towards more comprehensive Individual Needs Profiles (See ACC_20). Approaches to implementation: - Develop comprehensive categories for access needs, e.g. sensory, mobility, communication, cognitive, cultural - Train reception and clinical staff to sensitively identify and record access needs - Create clear protocols for how flagged needs translate into practice adjustments - Regularly review of flags with patients to ensure they remain accurate and helpful - Link flags to automatic prompts for specific accommodations Key benefits: Transforms access from a repeated struggle to a smooth process for patients with additional needs and demonstrates organisational commitment to inclusion for those with access needs.
  Advocacy and Policy	ADV_02	Equip GPs with Practical Advocacy Skills Provide training and resources to help GPs engage in effective advocacy at practice, local, and national levels.	Many GPs are passionate about advocacy but lack the practical skills or confidence to influence policy effectively. Training in media engagement, public speaking, and policy brief writing enables healthcare professionals to advocate for systemic change. Advocacy also plays a role in reducing burnout, as clinicians who engage in policy influence often feel a greater sense of agency and impact in their work. GPs witness daily how structural inequalities affect patient's health but may lack confidence or skills to advocate effectively for change. Building advocacy capacity transforms GPs from observers to active agents addressing the root causes of health inequalities. Approaches to implementation: - Share templates for advocacy letters to housing, benefits, and immigration services - Consider training in media engagement, public speaking, and policy brief writing - Provide training on different levels of advocacy: individual patient, practice population, and policy - Connect GPs with existing advocacy networks like Deep End groups - Create protected time for advocacy work within job plans - Document and share successful advocacy examples to build confidence Key benefits: Empowers GPs to address social determinants affecting their patients' health, builds collective voice for policy change on health inequalities, and positions general practice as a force for social justice beyond clinical care.
  Care for Focus Patients	CARE_09	Deliver culturally tailored smoking cessation support Offer personalised, non-judgemental smoking cessation support targeted at Focus Patients from groups with higher smoking rates and lower quit rates.	Smoking is more prevalent in groups experiencing social disadvantage, yet these patients are less likely to complete standard cessation pathways. Flexible, culturally sensitive support—delivered through trusted professionals and tailored to the person’s context—can significantly increase quit rates and reduce inequalities in long-term conditions such as COPD, stroke and cancer. Smoking remains the single largest driver of health inequalities, with rates significantly higher in deprived communities and some ethnic groups. Generic cessation approaches often fail to address the specific contexts and stressors that maintain smoking in marginalised populations. Approaches to implementation: - Analyse smoking patterns in your Focus Patient groups to understand specific contexts - Partner with community organisations to deliver culturally sensitive smoking cessation support - Offer cessation support in trusted community settings - Acknowledge and address the role of smoking in managing stress from poverty, discrimination, and trauma - Offer flexible support that recognises the competing priorities in patients' lives - Train staff in trauma-informed approaches to behaviour change conversations Key benefits: Addresses the largest modifiable cause of health inequalities through approaches that work for those most affected, reduces the disproportionate burden of smoking-related disease in marginalised communities, and demonstrates understanding of why standard cessation approaches often fail vulnerable groups.	Wiley: Online Library
  Care for Focus Patients	CARE_10	Annual Health Checks for People with a Learning Disability Deliver high-quality, person-centred annual health checks for all patients on the learning disability register, using a structured template, accessible communication, and a co-developed health action plan.	People with a learning disability die on average 20 years younger than the general population, often from preventable causes. High-quality annual health checks are crucial for identifying and addressing health issues early, but must be delivered in ways that work for each individual. Approaches to implementation: - Ensure all eligible patients are identified and invited using accessible communication methods, e.g. easy-read invitations - Allow longer appointments, attendance of trusted companions and offer familiar environments - Use easy-read materials and visual aids to support understanding - Address the full range of physical and mental health needs, using frameworks like NHS England's Annual Health Check for people with a learning disability - Co-develop health action plans that patients and carers can understand and use Key benefits: Directly addresses the stark mortality gap for people with a learning disability, provides comprehensive preventive care often missed in routine appointments, and demonstrates that the practice values the health of people with a learning disability equally.	NHS - Annual Health Checks LD
  Care for Focus Patients	CARE_11	Recognise and Support Carers Identify, record, and proactively support carers, including young carers, linking them to relevant information, services, and respite opportunities.	Carers, including family members, friends, and young carers, play a crucial role in the health and wellbeing of many patients. They may face significant health, financial, and social challenges themselves and often sacrifice their own health, yet remain invisible in healthcare systems. Proactive identification and support prevents carer breakdown, which might have devastating consequences for both the carer and those they care for. Approaches to implementation: - Implement systematic approaches to identify carers during all patient contacts - Maintain an accurate carers register with regular review - Provide information on carers’ rights, and signpost to local or national carers’ organisations. - Offer annual health checks focused on carer wellbeing and stress - Provide information about local carer support services and benefits - Recognise young carers who may be particularly hidden and vulnerable Key benefits: Supports the health of a population that typically neglects their own needs, supports the sustainability of informal care that the health system depends upon, and acknowledges carers as partners in care and deserving of support in their own right.	NHS - Support and benefits for carers NHS - Help for carers NHSE - Commitment to carers
  Care for Focus Patients	CARE_12	Veteran Friendly Practice Accreditation Work towards and achieve RCGP Veteran Friendly Practice accreditation to improve care for patients who have served in the UK Armed Forces.	Veterans face unique health challenges including higher rates of PTSD, substance misuse, and homelessness, yet often don't identify themselves or seek help due to military culture emphasising self-reliance. The RCGP Veteran Friendly Practice accreditation ensures practices can identify and support this overlooked population. Approaches to implementation: - Train staff to ask about military service and record veteran status - Ensure staff understand military culture and its impact on help-seeking behaviour - Understand common veteran health issues including mental health, hearing loss, and musculoskeletal problems - Build referral pathways to veteran-specific services and charities - Create visible signs of welcome such as displaying the Veterans' Covenant Key benefits: Improves identification and support for a population with health needs often unrecognised in general practice, demonstrates respect for military service whilst addressing health inequalities veterans face, and connects veterans with specialised support services they may not know exist.	RCGP eLearning - Guidance for GP's RCGP eLearning - Veteran's Health Hub
  Care for Focus Patients	CARE_13	Inclusive, Stigma-Free Care for Sex Workers Provide trauma-informed, non-judgemental, and accessible care for sex workers, ensuring services are flexible, inclusive, and supportive of holistic health needs.	Sex workers face significant health inequalities, with research showing they experience eight times higher mortality rates and multiple barriers to healthcare access. Stigma, criminalisation, and fear of judgement prevent many from disclosing their occupation or accessing timely care. Evidence from successful models like the Kirketon Road Centre iin Australia demonstrates that explicitly inclusive services dramatically improve health outcomes through building trust and removing barriers. Approaches to implementation: - Train all staff using a rights-based, harm reduction approach that recognises the diversity of sex work and sees it as work, challenging unconscious bias - Create clear confidentiality protocols that address sex workers' specific concerns about disclosure to police or social services - Develop flexible access arrangements including drop-in appointments and outreach partnerships with sex worker support organisations - Ensure holistic care that addresses physical and sexual health, mental health, substance use, and social needs without moral judgement - Display visual cues of inclusivity (such as the red umbrella symbol) and develop registration processes that don't require fixed addresses - Implement trauma-informed approaches, recognising that many sex workers have experienced violence or adverse experiences - Build partnerships with local and national specialist services, e.g. Basis Yorkshire, to provide wraparound support Key benefits: Reduces the stark health inequalities experienced by sex workers by creating genuinely accessible services, prevents crisis presentations through early intervention and trust-building, and demonstrates the practice's commitment to providing sanctuary and holistic and comprehensive care for all marginalised groups.	BASIS Yorkshire Red Umbrella Fund BMC
  Care for Focus Patients	CARE_14	Support Continuity of Maternity Care for Focus Patients Collaborate with midwifery teams to ensure Focus Patients receive safe, continuous care during pregnancy.	Maternal and infant mortality rates are significantly higher for women from deprived areas and minoritised ethnic communities. Supporting continuity of maternity care through collaborative working can help address these stark inequalities. Approaches to implementation: - Speak to your midwifery team about maternity care for Focus Patients and establish links with specialist midwifery teams for vulnerable women - Share relevant information about social circumstances, involving social prescribing and link workers - Work with midwifery, health visiting, and mental health teams to develop comprehensive, joined up postnatal follow-up to ensure smooth transitions back to primary care - Address social determinants affecting pregnancy through links with support services Key benefits: Contributes to reducing inequalities in maternal and infant mortality, ensures vulnerable pregnant women aren't lost between services, and demonstrates whole-system working to support those at highest risk.
  Continuity of Care	CONT_04	Make GP Working Patterns Transparent to Patients Publish GP schedules online so patients can choose appointments with their preferred clinician.	Patients often do not know when their usual GP is available, making it harder to book continuity-based appointments. Displaying working days for each GP on the practice website or patient messaging systems allows patients to plan their appointments around continuity. Continuity of care is supported if patients know when their preferred GP works, yet many practices treat working patterns as internal information. Transparency enables patients to make informed choices about whether to wait for continuity or see someone sooner. Approaches to implementation: - Publish GP working patterns on practice websites and in waiting areas - Include information about GP interests or specialisms to support patient choice - Explain how to book with specific GPs through different booking routes - Be clear about changes due to leave or training - Monitor whether transparency improves continuity rates Key benefits: Empowers patients to make informed decisions about continuity versus speed of access, reduces frustration from not knowing when preferred GPs work, and demonstrates transparency about practice operations.
  Continuity of Care	CONT_05	Introduce Proportionate Continuity for High-Need Patients Prioritise continuity for focus patients.	While continuity benefits all patients, Focus Patients will benefit more. Proportionate continuity ensures those who benefit most from continuity and therapeutic relationships receive them. Approaches to implementation: - Identify Focus Patients who would most benefit from relationship continuity - The RCGP Continuity of Care toolkit supports identifying cohorts for prioritised continuity based on clinical and social risk factors - Frequent attenders, patients with frailty, and those experiencing homelessness or trauma are among those who benefit most from continuity - Allocate these patients to specific GPs with protected appointment capacity - Create systems that default to continuity for these patients - Monitor continuity rates specifically for high-need groups - Balance continuity with access by offering choice of same-day or rapid access or waiting to see preferred GP Key benefits: Provides intensive relationship-based care to those who need it most, demonstrates proportionate universalism in practice, and improves outcomes for complex patients through consistent therapeutic relationships.	GMC
  Digital Inclusion	DIG_03	Develop Digital Navigation Roles Within Practices Train or recruit trusted staff or volunteers to act as ‘digital navigators’ actively supporting patients to use digital healthcare tools effectively.	Digital exclusion compounds health inequalities and some patients require personalised support, particularly older adults, those with limited literacy, cognitive impairments, or language barriers. Digital navigators help willing patients develop skills and confidence to access online services, ensuring digital transformation reduces rather than widens inequalities. Approaches to implementation: - Identify staff members or patient volunteers with communicationn and digital skills - Provide patient training sessions on the use of common digital health tools, such as the NHS App and e-consultations - Create regular drop-in sessions for digital support in the practice - Partner with local libraries or community centres to extend reach - Focus on building confidence, not just technical skills Key benefits: Transforms digital exclusion from a barrier to a surmountable challenge, enables patients to access digital services on their own terms, and demonstrates commitment to digital inclusion.	Good Things Foundation
  Digital Inclusion	DIG_04	Deliver Community-Based Digital Literacy Support Build partnerships with local voluntary organisations to deliver community-based and outreach digital literacy support, including pop-up sessions in trusted community spaces.	Community-led digital literacy sessions held in trusted venues—such as libraries, community centres, places of worship or housing schemes—help reach patients who may not attend the GP practice regularly or who face barriers to digital engagement. Working with local organisations ensures culturally relevant delivery and helps build trust with marginalised groups. Pop-up sessions can support patients with tasks like using the NHS App, booking appointments, accessing test results, or understanding remote consultations. This action helps ensure that digital transformation does not leave the most disadvantaged behind. Community-led digital literacy sessions held in trusted venues such as libraries, community centres, and faith spaces can reach patients who wouldn't attend practice-based training. Working with voluntary sector partners who already have relationships with digitally excluded communities creates safer, more accessible learning environments that address both skills and confidence barriers. Approaches to implementation: - Map local voluntary organisations already working with your Focus Patients and explore partnership opportunities for digital literacy support - Co-design digital literacy sessions that address specific healthcare tasks (booking appointments, ordering prescriptions, accessing results, using the NHS App) - Schedule sessions at varied times and locations to maximise accessibility, including evenings and weekends - Promote sessions through non-digital channels including posters in community venues, faith organisations, and word-of-mouth through trusted community leaders - Provide devices or data, where possible, through partnerships with digital inclusion schemes Key benefits: Builds digital confidence in familiar, trusted settings whilst strengthening practice relationships with community partners, ultimately reducing the digital divide that contributes to health inequalities.	Health Equity Evidence Centre
  Digital Inclusion	DIG_05	Provide Accessible Digital Tools with Multilingual and Easy-Read Support Ensure practice websites, apps, and digital platforms include translation, easy-read formats, and accessibility options.	Digital exclusion is often exacerbated by language, literacy, and accessibility barriers. Practices that provide digital solutions with multi-lingual options, easy-read formats, and accessibility features ensure their digital tools work for patients with diverse communication needs, including those with learning disabilities, visual impairments, or limited English proficiency. Approaches to implementation: - Audit current digital platforms for accessibility using available tools like WAVE - Ask digitally excluded Focus Patients to test and provide feed back on digital platforms - Implement translation for key digital pathways in your practice's most common community languages - Create easy-read versions of essential online processes with clear visuals and simple language - Ensure website compatibility with screen readers and include options for larger text and high contrast Key benefits: Creates genuinely inclusive digital services that work for all patients regardless of language, literacy, or disability, ensuring digital transformation doesn't deepen existing health inequalities.	NHS - Accessibility WAVE Health Equity Evidence Centre
  Health Literacy and Education	HLIT_03	Regularly Update Staff Knowledge on Community Health Resources Train reception and clinical staff to provide up-to-date information and signposting to local community health resources.	Patients frequently rely on reception staff and clinicians for guidance on community support, yet the landscape of local services changes rapidly. Regular training ensures all team members can effectively signpost patients to appropriate support, particularly those facing multiple disadvantages who may not know where else to turn. Approaches to implementation: - Create a centralised, regularly updated directory of local health and community resources - Cover this at new staff induction and schedule quarterly training sessions featuring presentations from local organisations - Assign a team member to maintain relationships with key community organisations - Develop quick reference guides for common signposting scenarios Include signposting competency in staff inductions and appraisals Key benefits: Empowers all staff to provide accurate, timely signposting that connects patients with vital community support, reducing pressure on clinical services whilst addressing wider determinants of health.
  Health Literacy and Education	HLIT_04	Provide Multilingual Self-Management Materials for Long-Term Conditions Develop or signpost accessible self-management information for long-term conditions (e.g., asthma, diabetes, hypertension) in multiple languages and formats.	Many patients with long-term conditions face language or literacy barriers that prevent effective self-management. Providing culturally appropriate, translated resources helps patients understand their conditions, recognise warning signs, and take appropriate action, reducing emergency presentations. An example would be sick day rules in type 2 diabetes. Approaches to implementation: - Identify the most prevalent long-term conditions among your Focus Patients and prioritise these for translation - Partner with local community groups to ensure translations are culturally appropriate, not just linguistically accurate - Use visual aids, videos, and pictorial instructions alongside written materials - Work with patient representatives to test materials - Distribute materials through multiple channels, including websites, social media, community venues and faith organisations Key benefits: Enables patients from minoritised ethnic communities to better manage their chronic conditions, reducing health inequalities in long-term condition outcomes and emergency admissions.	NHS - Health information in other languages
  Health Needs Assessment	HNA_04	Use Lived Experience to Shape Health Needs Assessments Engage patients with lived experience to help tailor how practices assess and respond to local population health needs.	Traditional health needs assessments often miss the voices of the most excluded communities. Incorporating lived experience ensures assessments capture the real barriers patients face and identifies solutions that will actually work. Approaches to implementation: - Recruit patients from your Focus Patient groups to advise on health needs assessment design - Use creative engagement methods such as community conversations, walking interviews, or photo-voice projects - Provide appropriate compensation for patients' time and expertise - Ensure findings directly influence practice priorities and service design - Share how patient input has shaped changes to maintain trust and encourage ongoing engagement Key benefits: Creates health needs assessments that truly reflect community needs and priorities, leading to more effective interventions that address the root causes of health inequalities.	National Voices Wiley - Online Library Health Equity Evidence Centre Point of Care Foundation SCie NHSE - Co-prodiction resource toolkit   BMA  - patient and public involvement - a tool kit for GPs Co-production guide for Northern Ireland NHS Tameside and Glossop co-production guide and toolkit
  Health Needs Assessment	HNA_05	Foster Collaboration Between Practices to Share Health Needs Assessment Work Enable networks of practices (e.g., PCNs) to work together on health needs assessment and equity initiatives.	Individual practices often lack the resources to conduct comprehensive health needs assessments. Collaborative approaches across networks or practices enable practices to pool resources, share expertise, and identify common challenges that require collective action. Approaches to implementation: - Establish a health equity working group across your locality - Share existing health needs assessments and identify common themes - Jointly commission deeper analysis of shared priority areas - Coordinate approaches to address identified needs, avoiding duplication - Create shared resources and interventions that all practices can adapt - Schedule regular review meetings to share learning and refine approaches Key benefits: Maximises limited resources through collaboration, creates more robust assessments through pooled data and expertise, and enables system-wide approaches to tackling health inequalities.
  Addressing Missingness	MISS_02	Introduce a 'Missingness Coordinator' function Designate a staff member or role to lead missingness work, coordinate support, and advocate for patients experiencing repeated disengagement.	Patients who repeatedly miss appointments often face the most complex barriers and the worst health outcomes. A dedicated coordinator function, perhaps included in the job-role of a link worker or social prescriber, ensures these patterns are noticed, understood, and addressed. Approaches to implementation: - Define the coordinator role, including monitoring patterns, coordinating outreach, and advocating for flexible responses - Provide protected time and training on trauma-informed approaches and motivational interviewing - Regular review of missingness data to identify trends and test new approaches - Establish pathways for staff to refer patients showing signs of disengagement - Create links with community organisations who may have contact with missing patients - Ensure the coordinator has authority to suggest and implement flexible solutions Key benefits: Creates accountability for addressing missingness, ensures coordinated rather than fragmented responses, and demonstrates institutional commitment to reaching those most at risk of poor health outcomes.	Focused care worker
  Addressing Missingness	MISS_03	Develop Individual Needs Profiles (e.g. PIN documents) for at-risk patients Use structured documents to record how specific patients prefer to be contacted and supported around care engagement.	Patients experiencing missingness or complex access needs require highly individualised approaches. Comprehensive Individual Needs Profiles go beyond basic adjustments to capture detailed information about communication, environmental, timing, and support needs, creating truly person-centred access. Approaches to implementation: - Co-design a simple template to capture contact and access preferences and support needs for suitable Focus Patients - Start with patients showing disengagement patterns, expanding to others with complex needs - Use profiles to inform appointment booking, reminder systems, service development and outreach approaches - Train staff to complete profiles collaboratively with patients - Flag clinical record and store profiles prominently for easy access by all team members - Review and update profiles regularly Key benefits: Reduces wasted appointments through more effective engagement strategies whilst demonstrating respect for patient autonomy and individual circumstances that may affect healthcare access.
  Multidisciplinary Team Approaches	MDT_03	Collaborate with Community and Welfare Services Formalise partnerships between practices and local welfare, housing, and community organisations to ensure integrated MDT responses for Focus Patients with complex social needs.	Focus Patients often face barriers that require broader responses beyond healthcare alone. Formal collaboration between primary care and local social, welfare, and housing providers enables coordinated, responsive MDT working, addressing both clinical needs and social determinants of health. Focus Patients often face multiple social challenges that drive poor health outcomes. Formal collaboration between primary care and social, welfare and community and voluntary organisations creates truly holistic responses. Approaches to implementation: - Map local welfare, housing, and community support organisations relevant to your Focus Patients (see NET_01) - Establish formal partnership agreements outlining roles, referral pathways, and information sharing - Create regular MDT meetings that include external partners, not just health professionals - Develop shared care plans that address both health and social needs - Provide space within the practice for partner organisations to deliver services - Evaluate partnership impact on both health outcomes and social circumstances Key benefits: Addresses root causes of health inequalities through integrated support, reduces the revolving door of crisis presentations, and builds more trusting relationships between statutory and community services.
  Networks of Support	NET_02	Establish Locality-Based Practice Collaboration Networks Actively collaborate with other local GP practices to share expertise, resources, and jointly address local health equity challenges.	Individual practices working alone have limited impact on area-wide health inequalities. When practices work together, for example through the Deep End movement, it enables resource-sharing, collective problem-solving, and coordinated approaches to common challenges. Approaches to implementation: - Initiate regular health equity meetings with neighbouring practices - Openly share successful interventions and learning - Identify common challenges that might benefit from joint approaches - Pool resources for shared initiatives such as translated materials or community engagement - Create buddy systems between practices with different strengths - Develop joint proposals for funding or system support - Celebrate and share successes to maintain momentum Key benefits: Amplifies impact through collective action, reduces duplication of effort, and creates peer support networks that sustain equity work even when individual practices face challenges.
  Minoritised Ethnic Communities	MIN_04	Promote Inclusive Social Prescribing and Signposting Develop a robust, culturally relevant mapping of local social prescribing and community referral options, community services, and wellbeing groups tailored to the needs of ethnic minority populations.	Patients from minoritised ethnic communities often face additional barriers to accessing social prescribing services due to language, cultural differences, or lack of culturally specific provision. Developing comprehensive knowledge of culturally appropriate community resources ensures equitable access to non-medical support. Approaches to implementation: - Map community organisations, faith groups, and cultural centres serving different ethnic communities (See NET_01 and MDT_03) - Build relationships with ethnic minority-led organisations to understand their services - Create multilingual directories of social prescribing options - Train link workers, social prescribers and other staff in cultural competence and anti-racist practice - Monitor uptake of social prescribing by ethnicity, to identify gaps Key benefits: Ensures social prescribing works for all communities by connecting patients to culturally relevant support, reducing isolation and improving wellbeing for those who may not engage with mainstream services.
  Minoritised Ethnic Communities	MIN_05	Embed Patient Experience Feedback Loops for Ethnic Minorities Establish robust feedback mechanisms specifically designed to understand the experiences and improve trust of patients from ethnic minority backgrounds.	Regular, culturally appropriate, anonymised feedback methods (e.g., surveys, patient forums) help practices identify gaps in care experienced by patients from ethnic minority backgrounds. Listening actively to patient experiences facilitates targeted actions to address discrimination, misunderstandings, and structural issues, enhancing trust. Standard patient feedback mechanisms often fail to capture experiences of minoritised ethnic communities due to language barriers, cultural differences in giving feedback, or lack of trust. Creating specific, culturally appropriate feedback routes ensures these voices are heard and acted upon. Approaches to implementation: - Develop multiple feedback channels including verbal, written, and digital options in relevant languages - Partner with community organisations to gather feedback in safe, trusted spaces - Use community researchers or peer interviewers who share language and cultural background - Ensure feedback specifically asks about experiences of discrimination or cultural safety - Create clear processes for how feedback will lead to changes - Report back to communities on actions taken in response to their feedback - Include ethnic minority patient representatives in practice decision-making forums Key benefits: Creates services that genuinely respond to the needs of all  communities, builds trust by demonstrating that feedback leads to change, and helps identify and address discriminatory practices or cultural barriers.
  Minoritised Ethnic Communities	MIN_06	Proactive Identification and Support for Ethnic Minority Patients Facing Disadvantage Proactively identify patients from an ethnic minority background experiencing structural disadvantage and offer tailored support pathways, ensuring their care needs are appropriately prioritised and managed.	Patients from minoritised ethnic communities experience multiple disadvantages and often face intersectional barriers to healthcare, including language difficulties, immigration concerns, and experiences of discrimination. Proactive identification enables targeted support before health crises occur, addressing the intersection of ethnicity with other forms of disadvantage. Approaches to implementation: - Analyse your ethnically minoritised Focus Patients data to identify patterns of low engagement - Cross-reference ethnicity data with other indicators of disadvantage (deprivation, housing status, language needs) - Develop targeted outreach strategies for identified groups, working with community organisations - Create care navigation support specifically for patients facing multiple barriers - Monitor health outcomes by ethnicity to track impact of interventions - Build trust through consistent, culturally safe interactions Key benefits: Reduces the compounded health inequalities faced by ethnic minority patients experiencing multiple disadvantages by early intervention and culturally appropriate support.	Health Equity Evidence Centre
  		Cultural Safety and Anti-Racism Training Deliver structured training on cultural safety, power dynamics, and anti-racist practice to create environments where patients from all backgrounds feel respected and heard.	Cultural safety goes beyond cultural awareness to address power imbalances and systemic racism in healthcare. Training that explores unconscious bias and develops practical skills for anti-racist practice helps create environments where patients from minoritised ethnic communities feel genuinely safe and respected. Approaches to implementation: - Commission training from organisations with expertise in anti-racism and cultural safety - Include all staff, from reception to clinical teams, recognising everyone's role in creating safety - Focus on practical scenarios and self-reflection rather than just knowledge transfer - Address specific issues like microaggressions, assumptions, and discriminatory practices - Create ongoing spaces for discussion and learning, not just one-off training - Measure impact through staff and patient feedback on experiences of discrimination and safety Key benefits: Creates genuinely inclusive healthcare environments where all patients receive equitable, respectful care, directly addressing the discrimination that drives ethnic health inequalities.
  Minoritised Ethnic Communities	MIN_08	Implement Inclusive Remote Consultation Practices	Remote consultations can inadvertently exclude ethnic minority patients through language barriers, lack of privacy in multigenerational households, or cultural preferences for in-person care. Adapting remote consultation practices ensures digital healthcare reduces rather than widens ethnic health inequalities. Approaches to implementation: - Offer choice between remote and face-to-face consultations without requiring justification - Ensure interpretation services work effectively in remote consultations - Provide guidance in multiple languages on how to access and use remote consultation platforms - Consider cultural factors such as gender preferences when scheduling remote appointments - Monitor uptake and outcomes of remote consultations by ethnicity Key benefits: Ensures the shift to digital healthcare includes rather than excludes ethnic minority communities, maintaining access while respecting cultural preferences and practical constraints.
  Minoritised Ethnic Communities	MIN_09	Use Cultural Events to Promote Preventive Health Recognise and incorporate relevant cultural events into practice activities to promote preventive healthcare messages such as screening, vaccination, or health checks.	Embedding health promotion into cultural celebrations (e.g., Black History Month, Diwali, Eid) helps practices connect meaningfully with communities. Culturally resonant campaigns increase engagement and uptake of services by delivering targeted, relatable messages in trusted contexts. Cultural and faith events (e.g., Black History Month, Diwali, Eid) provide trusted spaces where health information can reach communities who may not engage with traditional health promotion. Working respectfully within these contexts demonstrates cultural understanding and builds relationships that enhance future engagement. Approaches to implementation: - Map significant culture and religious events for your local communities - Partner with community and faith leaders to design appropriate health promotion activities - Offer health checks or vaccination clinics at community events - develop culturally tailored health messages that resonate with specific communities - Evaluate which approaches generate most engagement and benefits Key benefits: Reaches communities in trusted spaces, building relationships that improve long-term engagement with preventive healthcare and reducing inequalities in screening and vaccination uptake.	Health Equity Evidence Centre
  Research	RES_01	Become 'Research Ready' Through RCGP Accreditation Achieve RCGP Research Ready accreditation, equipping them with foundational skills and confidence to participate in primary care research	Research-active practices contribute to evidence that reflects their diverse populations' needs. RCGP Research Ready accreditation provides a framework for practices to build research capability, ensuring future studies include rather than overlook patients experiencing health inequalities. Approaches to implementation: - Complete the RCGP Research Ready self-assessment to identify gaps - Appoint a research champion to coordinate activity Key benefits: Contributes to building evidence that reflects the needs of all communities, whilst providing patients with access to innovative treatments and demonstrating the practice's commitment to addressing health inequalities through research.	DERA
  Addressing Stigma and Discrimination	STIG_02	Increase Staff Awareness of Stigma and Bias Provide team-wide training on stigma, discrimination, and unconscious bias, particularly for frontline staff.	Unconscious bias and stigma impact on healthcare quality and access, particularly for patients from marginalised groups. Training that helps staff recognise their own biases and understand how stigma impacts health is essential for creating truly inclusive services. Approaches to implementation:  - Deliver interactive training that encourages honest self-reflection about biases - Use real scenarios and patient stories to illustrate stigma's impact on health - Address specific stigmas prevalent in healthcare (mental health, substance use, sex work, obesity) - Create safe spaces for staff to discuss and challenge their assumptions - Develop practical strategies for interrupting bias in daily practice - Link training to broader equality and inclusion goals Key benefits: Reduces discriminatory practices and improves care quality for stigmatised groups, creating a practice environment where all patients receive respectful, equitable healthcare	Health Equity Evidence Centre Gender bias in pain eLearning course
  Addressing Stigma and Discrimination	STIG_03	Tackle Stigma within the Workforce Support an internal culture shift by addressing discrimination and stigma within staff teams	Staff from marginalised backgrounds often experience stigma within healthcare workplaces, affecting their wellbeing and ability to provide care. Creating psychologically safe environments for all staff improves workforce diversity, retention, and quality of care. Approaches to implementation: - Conduct anonymous staff surveys about experiences of discrimination and belonging - Establish zero-tolerance policies for discriminatory behaviour with clear reporting mechanisms - Review your Freedom to Speak Up arrangements (see resources) - Create staff networks or safe spaces for marginalised groups - Ensure recruitment and progression processes actively address bias - Provide mentoring and sponsorship for staff from underrepresented backgrounds - Celebrate diversity through visible leadership commitment and inclusive policies Key benefits: Creates healthier workplace cultures that support all staff to thrive, improving belonging and retention of diverse workforce and enabling staff to provide more empathetic, inclusive patient care.	National Guardian Care Quality Commission NHSE
  Addressing Stigma and Discrimination	STIG_04	Neuroaffirmative care Adopt a neuroaffirmative approach that recognises neurodiversity as natural variation, focusing on environmental adaptations to improve care for neurodivergent patients and staff.	Traditional healthcare environments often pathologise neurodivergence, creating barriers for autistic, ADHD, and other neurodivergent patients and staff. A neuroaffirmative approach recognises neurodiversity as natural variation, focussing on accepting and celebrating the unique strengths and perspectives of individuals with diverse neurological profiles, including those with autism, ADHD, and other neurodevelopmental conditions. Approaches to implementation: - Train all staff in neuroaffirmative principles and practical accommodations - Audit practice environments for sensory and communication barriers - Offer flexible appointment formats (written preparation, variable lengths, quiet times) - Use clear, direct communication and provide information in multiple formats - Create quiet spaces and reduce sensory overwhelm in waiting areas - Support neurodivergent staff with workplace accommodations and flexibility - Partner with neurodivergent-led organisations for guidance and training Key benefits: Creates genuinely inclusive healthcare for the significant proportion of patients who are neurodivergent, reducing mental health crises and improving engagement through environmental adaptation rather than expecting masking or compliance.	BMJ Leeds Autism Aims
  Team Education	EDU_03	Staff Training on Gypsy, Roma and Traveller Inclusion Provide training for all staff on understanding and addressing the needs of Gypsy, Roma and Traveller patients.	Gypsy, Roma and Traveller communities experience the starkest health inequalities of any ethnic group, compounded by widespread discrimination in healthcare settings. Comprehensive staff training that addresses both cultural understanding and anti-discriminatory practice is essential for improving access and outcomes. Approaches to implementation: - Commission training from Gypsy, Roma and Traveller-led organisations - Train staff and address common myths and stereotypes that fuel discrimination - Include practical guidance on registration rights and flexible service provision - Consider protocols for site visits and outreach services, working alongside health, care and community organisations where possible - Create accountability through monitoring of access and experience data Key benefits: Directly addresses the discrimination that creates barriers for Gypsy, Roma and Traveller patients, improving access to healthcare for communities experiencing the worst health outcomes.	Friends, Families & Travellers
  Team Education	EDU_04	Innovative Empathy-Building Education Use creative and multimedia resources (films, documentaries, music, visual arts, podcasts, books, storytelling) within training sessions to explicitly build staff empathy towards diverse patient groups.	Traditional diversity training often fails to create lasting change in attitudes and behaviours. Innovative approaches using storytelling, simulation, and creative methods help staff emotionally connect with patient experiences, building genuine empathy that transforms practice. Approaches to implementation: - Use immersive simulations to experience healthcare from marginalised patients' perspectives - Share video stories and podcasts featuring patient voices and experiences - Facilitate reflective discussions about emotional responses to patient stories -Create shadowing opportunities with community organisations - Use forum theatre or role-play to practice challenging scenarios - Measure impact through patient feedback on staff empathy and understanding Key benefits: Builds deeper understanding and emotional connection that drives sustained behaviour change, creating more compassionate care for patients facing multiple disadvantages.
  Team Wellbeing	WELL_04	Establish Structured Reflective Practice Sessions Provide regular reflective practice opportunities, such as Balint groups or facilitated reflective sessions, supporting staff wellbeing and effective trauma-informed care.	Working with patients experiencing health inequalities can be emotionally demanding, leading to moral distress, vicarious trauma and burnout. Structured reflective practice provides space to process complex cases, share learning, and maintain resilience while improving the quality of care. Approaches to implementation: -Schedule protected time for regular reflective practice sessions within your practice and networks -Where possible, use trained facilitators to create psychologically safe spaces -Focus sessions on health equity challenges and their emotional impact -Include all team members, recognising everyone's contribution to equity work Key benefits: Supports staff wellbeing and prevents burnout while improving team learning and responses to complex health inequality challenges.	National Wellbeing Hub
  Trauma-Informed and Enabled Care	TIC_02	Implement Trauma-Informed Care into Routine Practice Embed trauma-informed principles into everyday interactions and systems within the practice, making it a routine aspect of patient and staff experiences.	Many patients experiencing health inequalities have trauma histories that affect their health and healthcare engagement. Embedding trauma-informed principles throughout the practice prevents retraumatisation and creates healing environments that support better health outcomes. Approaches to implementation: -Train all staff in trauma-informed principles and their practical application -Redesign patient pathways to maximise choice and control -Create calm, predictable environments that promote safety -Develop protocols for managing trauma responses -Ensure clinical discussions consider trauma as a potential factor in presentations -Build partnerships with trauma specialist services -Monitor patient feedback on feelings of safety and respect Key benefits: Creates healthcare environments that promote healing rather than retraumatisation, improving engagement and outcomes for the many patients affected by trauma.	WILEY
  Values and Behaviours	VAL_03	Use Reflective Tools to Explore Bias and Assumptions Facilitate structured reflection on values, assumptions and decision-making using stories, debriefs, or simulation.	Personal biases and assumptions unconsciously influence clinical decisions and patient interactions, contributing to health inequalities. Structured reflection using approaches like Schwartz Rounds helps staff explore the emotional aspects of care and recognise how their assumptions affect patient outcomes. Approaches to implementation: -Create regular protected time for team reflection on challenging cases involving bias -Introduce Schwartz Rounds or similar structured reflective forums focusing on emotional aspects of care -Use bias interruption tools and decision audits in clinical practice -Encourage storytelling about times when bias, stereotyping or assumptions affected care -Foster psychological safety so staff can admit mistakes without judgement -Link reflection to real changes in practice behaviour -Include diverse voices in reflective sessions to surface different perspectives Key benefits: Develops emotionally aware practitioners who understand how their feelings and biases impact care, leading to more equitable treatment for marginalised groups.	The Point of Care Foundation Gender bias in pain eLearning course

• Leading Action

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  Leading

  Theme	Action Tier	Action Code	Action Descriptor	Supporting Information	Supporting Resources
  Access and Flexibility	Leading	ACC_19	Walk-in clinics for Focus Patient Groups Establish dedicated walk-in or outreach services in community hubs for those facing significant barriers.	Traditional appointment systems create barriers for many experiencing the worst health inequalities. Dedicated walk-in clinics designed around specific communities' needs provide accessible care that prevents health crises and builds trust. Approaches to implementation: - Consult Focus Patients about optimal timing, location, and service design - Staff clinics with professionals experienced in inclusion health - Provide comprehensive services including mental health and social support - Create welcoming environments that reduce stigma and fear - Partner with community organisations to promote and support access - Monitor who attends to ensure reaching intended communities Key benefits: Provides genuinely accessible healthcare for those most excluded from traditional services, preventing deterioration and demonstrating innovative approaches to tackling health inequalities.	HEEC EBCD SCie NHSE BMA Dept of Health NHS BJGP
  Access and Flexibility	Leading	ACC_20	Patient participation and co-design of access policies Develop and sustain engagement and co-production groups to ensure patient voices shape access policies.	Access policies designed without input from marginalised communities often inadvertently create barriers. Meaningful co-design with Focus Patients ensures policies work for those who most need healthcare, embodying "nothing about us without us" principles. Approaches to implementation: - Recruit diverse Focus Patients as equal partners in policy design - Provide appropriate compensation and support for participation - Use creative engagement methods beyond traditional meetings - Ensure decision-making power, not just consultation - Test policies with Focus Patients before implementation - Create feedback loops to refine policies based on real experience Key benefits: Creates access policies that genuinely work for marginalised communities, building trust through demonstrating that patient voices lead to real change.	Health Equity  Evidence Centre Health Equity Evidence Centre EBCD SCie NHSE BMA Department of Health NHS WILEY - Online Library
  Access and Flexibility	Leading	ACC_21	Integrate Community Outreach into Routine Practice Develop structured outreach initiatives to engage underserved populations and improve service access.	Many experiencing health inequalities cannot or will not access practice-based services. Integrating outreach into care delivery demonstrates a commitment to serving the whole community, taking healthcare to where people are rather than expecting them to come to you. Approaches to implementation: - Map where Focus Patients naturally gather and feel safe - Develop regular outreach clinics in community settings - Include outreach in job plans and practice budgets, not as extras - Partner with trusted community organisations as hosts and bridges - Provide comprehensive services during outreach, not just signposting - Build relationships over time through consistent presence - Share learning about effective outreach across the system Key benefits: Reaches those most excluded from healthcare in trusted spaces, reducing inequalities and demonstrating how practices can reshape themselves around community needs.	Health Equity Evidence Centre
  Access and Flexibility	Leading	ACC_22	Introduce peer navigators Employ individuals with lived experience to support vulnerable patients in accessing care.	Peer navigators are trained individuals with relevant lived experience. They can provide uniquely effective support, bridging communities and healthcare systems. Their shared experiences build trust and understanding that GP staff alone cannot achieve. Approaches to implementation: - Recruit peer navigators from the communities you serve - Provide comprehensive training while valuing lived experience - Create meaningful roles with appropriate reward - Ensure peer navigators have genuine influence on service design - Provide regular supervision and support - Build clear boundaries while maintaining peer relationships - Evaluate impact on patient engagement and outcomes Key benefits: Transforms patient engagement through trusted relationships with those who truly understand their experiences, demonstrating how lived experience expertise can reshape healthcare delivery.	Health Equity Evidence Centre
  Advocacy and Policy	Leading	ADV_03	Strengthen Partnerships with Third-Sector Organisations Create and maintain mechanisms of partnership working between GP practices and third-sector organisations working on health inequalities.	Third-sector organisations often hold trusted relationships with marginalised communities and understand their needs. Equitable partnerships that value this expertise create comprehensive support systems addressing health inequalities. Approaches to implementation: - Map third-sector organisations working with your Focus Patients (see NET_01 and MDT_03) - Develop partnerships based on shared power and mutual respect - Create agreements clarifying roles - Involve community partners in strategic decisions - Build bidirectional referral pathways and communication systems - Joint advocacy for system changes benefiting marginalised groups Key benefits: Creates comprehensive support networks leveraging community assets and relationships, demonstrating how primary care can work as part of broader movements for health equity.	National Voices The Health Foundation
  Care for Focus Patients	Leading	CARE_15	Achieve Pride in Practice Accreditation Work towards and achieve Pride in Practice accreditation to demonstrate commitment to LGBTQ+ inclusive care.	LGBTQ+ people face significant health inequalities including mental health disparities, barriers to accessing care, and experiences of discrimination. Pride in Practice accreditation provides a framework for systematically addressing these inequalities through service improvement. Approaches to implementation: - Complete baseline assessment against Pride in Practice criteria - Establish LGBTQ+ inclusion working group including patient representatives - Implement comprehensive staff training on LGBTQ+ health needs and inclusive practice - Review all policies and forms for heteronormative assumptions - Create visible indicators of LGBTQ+ inclusion throughout the practice - Develop specific pathways for trans and non-binary healthcare - Monitor sexual orientation and gender identity data to track inequalities - Celebrate achievement and maintain ongoing improvement Key benefits: Creates systematically inclusive healthcare for LGBTQ+ patients, addressing the discrimination and barriers that drive significant health inequalities in these communities.	LGBT Foundation
  Care for Focus Patients	Leading	CARE_16	Run a targeted cancer screening improvement initiative Design and deliver a short campaign to increase screening uptake (e.g. bowel, breast, cervical) among underrepresented groups.	Cancer screening uptake shows stark inequalities, with lower participation among deprived communities, ethnically minoritised communities, and other marginalised groups. Targeted initiatives that address specific barriers can significantly improve early detection and survival rates. Approaches to implementation: - Analyse screening data in your Focus Patients, including by deprivation, ethnicity, and other equity markers - Co-design interventions with communities with low uptake - Address practical barriers including appointment times, transport, and childcare - Provide culturally appropriate information addressing specific concerns - Train staff to have sensitive conversations about screening - Use text reminders in multiple languages with clear call-to-action - Partner with community organisations to promote screening - Evaluate impact and share learning across the system Key benefits: Reduces inequalities in cancer outcomes through improved early detection among groups currently underserved by screening programmes.	Health Equity Evidence Centre
  Continuity of Care	Leading	CONT_06	Introduce MDTs for Priority Continuity Establish small, dedicated teams to proactively manage continuity for patients facing severe and multiple disadvantages.	Focus Patients with complex needs benefit most from continuity but often receive fragmented care. Small, dedicated multidisciplinary teams - sometimes known as microteams - working with defined caseloads can provide the consistent, coordinated care these patients need to. Approaches to implementation: - Use clinical judgement and data to Identify patients who would most benefit - Form small MDTs with protected time for discussion and coordination of care - Include diverse professionals based on patient needs - Schedule regular team meetings to discuss all patients - Create shared care plans accessible to all team members - Monitor patient outcomes and experience of continuity - Share learning about effective team models Key benefits: Provides genuine continuity and coordination for patients with complex needs, reducing crisis admissions and improving both clinical outcomes and patient experience.	NICE NG214 GMC
  Continuity of Care	Leading	CONT_07	Adjust Appointment Lengths to Support Continuity and Workforce Retention Review appointment structures to ensure safe workloads, reducing GP burnout and improving continuity.	10 minute appointment slots create pressure that undermines quality of care, continuity and clinician wellbeing. Flexible appointment lengths improve care quality, reduce stress, and support workforce retention. Approaches to implementation: - Analyse consultation patterns to understand which patients or groups may require more time - Pilot different appointment lengths for different consultation types, including interpreted consultations - Build flexibility for clinicians to extend appointments when needed - Monitor impact on patient satisfaction and clinical outcomes Key benefits: Improves care quality for complex patients while supporting clinician wellbeing and retention, creating sustainable models for addressing health inequalities.
  Digital Inclusion	Leading	DIG_06	Establish Device Access Scheme for Digitally Excluded Patients Work with libraries, local VCSEs, or PCNs to create a device loan or donation scheme to support patients without access to smartphones or tablets for online care.	Digital poverty prevents many patients from accessing increasingly digital healthcare services. Device lending schemes address the root cause of digital exclusion, ensuring poverty doesn't determine access to modern healthcare. Approaches to implementation: - Partner with digital inclusion charities and local businesses - Identify patients unable to access services due to lack of devices - Provide tablets or smartphones with data packages included - Offer basic digital skills training - Create simple guides for using devices for health tasks - Build in technical support through volunteers or staff - Monitor usage and impact on healthcare access Key benefits: Removes fundamental barriers to digital healthcare for patients in poverty, preventing digital transformation from widening health inequalities.
  Digital Inclusion	Leading	DIG_07	Provide Digital Access Points in Waiting Areas Install secure tablets or computer stands in waiting rooms to allow patients to access health information, book appointments, or complete forms with staff support if needed.	Many patients lack devices, data, or confidence to use digital health services at home. Providing supported digital access points within the practice enables digital engagement while maintaining human support for those who need it. Approaches to implementation: - Install secure tablets or computers in accessible, visible locations - Ensure privacy for sensitive health tasks - Train reception staff to provide basic digital support - Create simple visual guides displayed near devices - Offer headphones for accessibility and privacy - Monitor usage to understand digital needs - Maintain non-digital alternatives alongside digital options Key benefits: Bridges the digital divide by providing supported access within familiar healthcare settings, ensuring digital services remain inclusive.
  Health Literacy and Education	Leading	HLIT_05	Embed Diverse Representation in Patient Education Resources Ensure that educational materials and websites reflect the diversity of the community, using inclusive visuals, names, and real-life case studies from varied ethnic and cultural backgrounds.	Patient education materials that only represent majority populations alienate marginalised communities and may not address their specific needs. Diverse, representative resources improve engagement and health literacy across all communities. Approaches to implementation: - Audit existing materials for representation gaps - Co-create materials with diverse community members - Use images reflecting age, ethnicity, disability, and body diversity - Include culturally relevant examples and scenarios - Test materials with intended audiences - Source materials from community-led organisations Key benefits: Improves health literacy and engagement by ensuring all patients see themselves reflected in health information, reducing inequalities in health knowledge and self-care.
  Health Literacy and Education	Leading	HLIT_06	Link Practices with Community-Based Health Education Initiatives Partner with community organisations to deliver culturally relevant, community-led health education programmes.	Many experiencing health inequalities don't engage with practice-based health education. Partnerships with community organisations enable health education delivery in trusted spaces where marginalised groups already gather. Approaches to implementation: - Map community organisations working with your Focus Patients (see NET_01 and MDT_03) - Co-design health education topics based on community priorities - Deliver sessions in community venues at accessible times - Where possible, use peer educators from within communities - Provide resources for ongoing community-led health promotion - Evaluate reach and impact on health behaviours - Build sustainable partnerships beyond individual projects Key benefits: Reaches communities in their own spaces with trusted messengers, improving health literacy among groups least likely to engage with traditional health education.
  Health Needs Assessment	Leading	HNA_06	Develop Community-Based Approaches to Support Self-Care and Reduce Reactive Demand Mobilise community assets and third-sector partnerships to create sustainable support models beyond traditional clinical care.	Patients from marginalised communities experience higher emergency and readmission rates. Comprehensive and holistic approaches addressing both social and medical can break cycles of crisis and admission. Approaches to implementation: - Map admission patterns to identify Focus Patients at highest risk - Develop partnerships across health, social care, and voluntary sectors - Create integrated discharge planning involving community support - Establish peer support networks for condition management - Address social factors that undermine self-care - Provide intensive support during high-risk transition periods - Share successful models across the system Key benefits: Reduces inequalities in emergency admissions by providing wrap-around community support that addresses both medical and social factors affecting health.	fairhealth NHS Confederation Health Equity Evidence Centre
  Addressing Missingness	Leading	MISS_04	Address transport and logistical barriers to care Use a stepped approach to remove transport barriers—ranging from travel vouchers to direct accompaniment, depending on need.	Transport	Health Equity Evidence Centre
  Multidisciplinary Team Approaches	Leading	MDT_04	Embed Care Coordinators Within MDTs Integrate dedicated care coordinators into multidisciplinary teams to ensure personalised, proactive support for marginalised Focus Patients.	Patients with complex needs often fall through gaps between services despite MDT involvement. Dedicated care coordinators with responsibility for Focus Patients ensure plans translate into coordinated action and nothing is missed. Approaches to implementation: - Define care coordinator role including responsibilities - Recruit coordinators with skills in navigation and advocacy - Embed coordinators as equal MDT members and empower them to challenge when plans aren't implemented - Create systems for coordinators to track all actions - Build relationships across all services involved - Monitor impact on patient experience and outcomes Key benefits: Transforms MDT effectiveness by ensuring comprehensive plans become coordinated reality, particularly benefiting patients facing multiple disadvantages who struggle to navigate complex systems.	National Library of Medicine Focused Care Carey G, Crammond B, De Leeuw E (2015) Towards health equity: a framework for the application of proportionate universalism Int J Equity Health BJGP
  Minoritised Ethnic Communities	Leading	MIN_10	Encourage Inclusive Participation in Patient Groups Review and adapt communications about patient participation groups (PPGs) to ensure inclusivity, particularly for minoritised ethnic communities (e.g., inclusive language and visuals in flyers, text messages, and outreach).	Traditional patient participation groups rarely reflect ethnic diversity, missing crucial perspectives on health inequalities. Inclusive participation requires intentional restructuring to enable meaningful involvement from all communities. Approaches to implementation: - Audit current patient participation against community ethnicity demographics - Remove barriers including meeting times, locations, and languages - Consider participation payments that recognise expertise - Use diverse engagement methods beyond formal meetings - Build relationships with community organisations supporting ethnically minoritised people - Create specific roles for ethnically minoritised people - Ensure genuine influence on decisions, not tokenism - Support participants to engage effectively Key benefits: Ensures practice development reflects all communities' needs, addressing blind spots and building services that work for everyone.
  Minoritised Ethnic Communities	Leading	MIN_11	Collaborate Across the Local System to Tackle Ethnic Health Inequalities Use ethnicity-related insights from your practice to inform neighbourhood or locality-level initiatives aimed at reducing racial health inequalities.	Ethnic health inequalities require system-wide responses. Leading collaborative initiatives demonstrates how primary care can catalyse broader change through coordinated efforts. Approaches to implementation: - Share data on ethnic health inequalities across the local system - Convene partners including from your network of practices and community organisations - Develop a shared vision and coordinated action plans - Pool resources for greater impact - Create shared learning networks - Advocate together for policy changes - Monitor system-wide progress on ethnic health equity - Celebrate successes and maintain momentum Key benefits: Amplifies impact through system-wide coordination, addressing ethnic health inequalities at scale while positioning primary care as leaders in health equity.
  Research	Leading	RES_02	Actively Participate in Research Studies Focused on Health Equity Collaborate proactively with academic and research institutions to engage in or host research studies explicitly targeting health inequalities and inclusion health populations.	Research often excludes marginalised populations, perpetuating evidence gaps about what works to reduce health inequalities. Active participation in equity-focused research helps build evidence that reflects all communities' needs. Approaches to implementation: - Join the Deep End Research Alliance to build relationships with other practices and research teams interested in health inequalities - Support recruitment from underserved communities and establish systems for identifying and recruiting patients from underserved groups - Identify and engage with research projects focusing on health inequalities - Advocate for inclusive research design and recruitment - Ensure research participation information is available in multiple formats and languages - Create feedback mechanisms to share research findings with participating communities Key benefits: Contributes to building robust evidence about reducing health inequalities while providing marginalised patients the opportunity to contribute to research opportunities.	DERA
  Addressing Stigma and Discrimination	Leading	STIG_05	Proactively Identify and Address Candidacy Barriers Review practice systems to ensure that all patients feel entitled to and welcomed in primary care.	Candidacy' describes how patients judge themselves as legitimate users of healthcare. Marginalised groups often feel undeserving or unwelcome due to past experiences and systemic barriers. Proactive efforts promote inclusion. Approaches to implementation: - Map the patient journey and practice environment, identifying potential candidacy barriers - Consult marginalised patients about when they feel unwelcome - Review language in all communications for inclusivity - Train staff to actively welcome and affirm all patients - Create visible signs of inclusion throughout practice - Address specific barriers for stigmatised groups - Monitor missingness patterns as indicator of candidacy issues - Share learning about promoting candidacy Key benefits: Transforms practice culture to actively include those who feel least deserving of care, addressing a fundamental driver of health inequalities.
  Addressing Stigma and Discrimination	Leading	STIG_06	Develop Patient-Led Approaches to Combat Stigma Engage patients with lived experience to shape inclusive policies and reduce stigma.	Traditional anti-stigma training often fails to create lasting change. Patient-led approaches drawing on lived experience of stigma create more powerful learning that transforms attitudes and behaviours. Approaches to implementation: - Recruit patients with lived experience of health-related stigma - Support them to co-design anti-stigma initiatives - Create safe spaces for sharing stigma experiences - Develop staff trainign that is patient-led - Use creative methods including storytelling and arts - Ensure patient leaders are properly compensated - Evaluate impact on staff attitudes and patient experience - Build network of anti-stigma champions Key benefits: Creates authentic, powerful anti-stigma interventions that transform practice culture through the authority of lived experience.	EBCD WILEY - Online Library Health Equity Evidence Centre EBCD SCie NHSE BMA Department of Health NHS
  Structural Competence	Leading	STR_02	Regular Practice-Based Structural Competence Discussions Incorporate regular structured conversations about structural competence into existing team meetings or protected learning time.	Healthcare often focuses on individual behaviour while ignoring structural factors that contribute to poor health. Regular discussions about structural barriers builds team capacity to recognise and respond to systemic inequities affecting patients. Approaches to implementation: - Schedule regular discussions about structural barriers - Use case discussions to explore structural influences, linking structural factors to clinical presentations - Invite external speakers on housing, immigration, welfare - Create safe spaces to discuss systemic racism and discrimination - Develop practice responses to common structural barriers - Document learning and actions taken Key benefits: Builds sophisticated understanding of how structural factors drive health inequalities, enabling more effective responses that address root causes.
  Structural Competence	Leading	STR_03	Co-located welfare and health services  Integrate services such as Citizen’s Advice or housing support within GP practices.	Social determinants drive the majority of health inequalities, yet traditional healthcare struggles to address them. Co-locating welfare services within practices enables immediate support for the poverty, housing, and legal issues that undermine health. Approaches to implementation: - Map the most pressing social needs among your Focus Patients - Approach relevant organisations about co-location partnerships - Allocate appropriate space and establish clear referral pathways - Develop information sharing agreements - Train staff to recognise social welfare needs and signpost appropriately Key benefits: Addresses root causes of poor health through integrated support, reducing crisis presentations and demonstrating how primary care can tackle wider determinants of health inequalities.	Pathway Scottish Govt BJGP BMC
  Team Wellbeing	Leading	WELL_05	Facilitate Trauma-Informed Debrief Sessions Provide protected, structured debrief sessions following critical or emotionally challenging incidents, ensuring they are trauma-informed and inclusive of all team members.	After difficult incidents, trauma-informed debriefs help staff process emotional stress, prevent trauma accumulation, and support recovery. Working with trauma and severe inequities takes an emotional toll on staff, risking secondary trauma and burnout. Structured debriefs provide essential space for processing difficult experiences while learning together. Approaches to implementation: - Create a protocol for identifying when debriefs may be needed, e.g., after an incident of violence or abuse - Engaged trained facilitators in trauma-informed debrief techniques - Provide immediate and follow-up debrief opportunities - Include all staff involved, recognising everyone's impact - Focus on emotional processing alongside learning - Normalise seeking support after difficult cases Key benefits: Protects staff wellbeing while improving responses to trauma and complexity, creating sustainable workforce capacity for addressing health inequalities.
  Trauma-Informed and Enabled Care	Leading	TIC_04	Develop Trauma-Enabled Practice Infrastructure Create the necessary infrastructure and resources, such as accessible psychological support, to sustain trauma-informed care effectively across the practice.	Trauma-informed training alone rarely creates lasting change without supporting infrastructure. Building trauma principles into systems, policies, and culture ensures sustainable transformation that benefits all patients affected by trauma. Approaches to implementation: - Align all practice policies and procedures with trauma-informed principles - Designate and support trauma champions with protected leadership time - Incorporate trauma-informed considerations into routine risk and safeguarding assessments - Develop structured care pathways for patients disclosing or showing signs of trauma - Offer regular supervision or reflective practice sessions focused on trauma and compassion fatigue - Systematically collect and act on patient feedback relating to psychological safety, empowerment and choice - Review physical spaces to reduce triggers and promote calm, dignity and a sense of control - Work with commissioners to embed trauma-informed metrics and models in service design and funding Key benefits: Creates lasting transformation in how practices respond to trauma, improving outcomes for the many patients whose health is affected by traumatic experiences.	WILEY - Online Library PMC
  Values and Behaviours	Leading	VAL_04	Embed Equity-Related Values into Recruitment, Appraisal and Leadership Align recruitment, supervision and leadership development with your practice’s values and equity goals.	Lasting change requires embedding equity focused values into the practice's DNA. Building health equity into recruitment, appraisal, and leadership development ensures committed people are recruited, supported, and promoted. Approaches to implementation: - Include your equity commitment in all job descriptions - Assess values and attitudes during recruitment - Build equity objectives into appraisals - Recognise and reward equity work - Develop equity-focused leadership programmes - Ensure diverse recruitment and promotion panels - Monitor workforce diversity at all levels - Create progression pathways for equity roles and champions Key benefits: Creates sustainable culture change by ensuring health equity remains central to practice identity regardless of individual staff changes.