UCL Institute of Health Informatics


Right to Care

Improving access to primary care for inclusion health groups in the UK.

Everyone living in the United Kingdom is entitled to access free primary care. Despite this, inverse care persists for people in need of healthcare who are wrongly being refused access to General Practice (GP) surgeries. This problem is widespread and affects many of the most marginalised groups in our society, including asylum seekers; undocumented migrants; people from Gypsy, Roma and Traveller communities; people who sell sex; and people experiencing homelessness or with substance use disorders. Collectively, these populations are termed inclusion health groups. Outreach teams like Find & Treat (F&T) and Doctors of the World (DoTW) provide healthcare for inclusion health groups in the community and work to effectively integrate them into mainstream NHS services. 

The aim of the Right to Care study is to improve national access to primary care by improving GP registration for inclusion health groups by developing two interventions that will be delivered at the service user and GP practice level.

DoTW helps service users register with a GP in two ways: first, by calling the GP to help register patients and second, by helping GP practices to register inclusion health patients through a training programme (Safe Surgeries). These current interventions were developed organically to meet presenting needs of service users. They are resource intensive and have never been systematically evaluated. Moreover, as a majority of DoTW service users are migrants, DoTW current interventions are focussed on how to best support the unique health needs and barriers experienced by migrants compared to other inclusion health groups. 

Therefore, there is a demonstrated need to build on and redevelop the current DoTW interventions to more effectively address the needs of broader inclusion health groups and extend these to a larger geographical range. Partnering with UCLH and F&T to better understand the needs of other inclusion health population groups will be an essential developmental step.

The work will be conducted in three stages to develop two interventions in parallel.

Intervention 1: an awareness-based tool for GP registration for inclusion health groups 

Initially, the study team will conduct a needs assessment of the existing advocacy-based intervention, through surveys and interviews of existing DoTW and F&T service users, stakeholders working with these groups, and primary care staff. Following this, the team will host multi-stakeholder co-production workshops to design the tool. The team will then co-develop the tool and conduct feasibility testing of trialling this intervention, particularly of the strategies for recruitment, delivery and follow up. 

Intervention 2: a scalable training, resources and support programme to facilitate inclusion group registration for GP surgeries

The study team will conduct a programme evaluation of DoTW’s Safe Surgeries Initiative, through surveys and interviews with primary care staff, CCG staff, inclusion health service users and stakeholders that work with them. The team will then host multi-stakeholder co-production workshops to design the new programme. It will subsequently be developed with input from service users. Finally, the team will conduct feasibility testing of trialling this programme, in a number of GP practices across the UK.

The Right to Care project is coordinated by Rachel Burns and chief investigator Robert Aldridge

If you are interested in learning more about the project or for potential collaborations, please do get in touch.