Tackling health inequalities together: inclusion health and co-production

Introduction Trauma-informed approaches acknowledge the impact of trauma on the health of patients and staff, and the ways in which health care is accessed and experienced.1 There is growing interest in these approaches in both a UK and international primary care context.2 Intrinsic to a trauma-informed approach (although rarely achieved in practice)2 is the co-production of health services with those with relevant lived experience. Existing models of patient involvement in primary care tend to rely significantly on feedback forms or surveys, which do not facilitate an ongoing dialogue between patients and healthcare providers. Patient participation groups (PPGs) can provide a more meaningful space in which services can be truly co-produced, in particular where careful attention is given to power dynamics in the room.3 There is, however, an increasing understanding of the need for flexibility in our approaches to patient involvement, which should incorporate multiple models, recognising individuals’ diverse experiences, preferences, and capacity for participation.3 The Care Quality Commission (CQC) suggests that we may have ‘… more effective conversations through engaging with different community groups at different times and in different places’.4 The need for provision of protected spaces with careful attention to sociocultural backgrounds and power dynamics is echoed within the principles of trauma-informed care.1 The current authors have worked proactively with specific community groups who are often poorly served by our health services. We have sought to create protected spaces and mitigate existing power dynamics to support the free communication of ideas, working together with partnership organisations to improve local primary care provision.