Improving access to general practice for and with people with severe and multiple disadvantage

Background: People with severe and multiple disadvantage (SMD- combinations of homelessness, substance misuse, violence, abuse and poor mental health) have high health needs and poor access to primary care. Aim: To explore perceptions and experiences of improving access to general practice for people with SMD in healthcare staff and people with lived experience. Design and Setting: Bridging Gaps is a collaboration between healthcare staff, researchers, women with lived experience of SMD and a charity that supports them in a UK city. We co-produced a project to improve access to general practice for people with SMD, that was further developed with 3 inner city general practices. Method: We facilitated nine service improvement meetings at three general practices and formally observed six of these. We interviewed nine practice staff and four participants with lived experience. Three participants with lived experience and one staff member who supports them participated in a focus group. Data was analysed inductively and deductively using thematic analysis. Results: Enabling motivated general practice staff with time and funding opportunities, galvanised by lived experience involvement, resulted in service changes. These included: prioritising patients on an inclusion patient list with more flexible access, continuity from a care coordinator and micro-team, and an information sharing tool. The process and outcomes improved connections within and between general practices, support organisations and people with SMD. Conclusion: These co-designed strategies could be locally adapted and evaluated in other areas. Investing in this focused way of working may improve healthcare accessibility, health equity and staff wellbeing.