Making primary care accessible to people who experience multiple health inequalities

A new co-produced clinic is changing the way people with complex needs, such as addiction and mental ill-health, access mainstream healthcare. Open Doors, the new clinic at Wellspring GP surgery in Bristol, has been designed with people with complex health needs. The clinic could be instrumental in helping healthcare professionals identify and support marginalised patients who may otherwise struggle to access and engage with primary care.

Open Doors was initiated and co-designed with women with complex needs, as part of the Bridging Gaps project. Bridging Gaps is a group of women who have experienced extensive trauma such as sexual violence and exploitation, domestic abuse, homelessness and having children taken into care. The women saw that healthcare services such as GP surgeries are often ill-equipped to meet complex needs, worsening already severe health inequalities. Women have shared their reasons for disengaging from healthcare, for example because of stigma, discrimination and re-traumatisation.

Bridging Gaps offers health professionals a greater understanding and awareness of the needs and trauma of such patients. The group works with professionals to improve services.

They have run trauma-informed care training to five GP surgeries. They are working with three surgeries in more depth to help improve access for those who need support most but who are often excluded or face barriers to accessing primary care. The team who developed Bridging Gaps includes women with lived experience, GPs, NIHR ARC West and University of Bristol researchers, the local clinical commissioning group and One25, a charity supporting some of Bristol’s most marginalised women.

Since its inception, Bridging Gaps has helped to increase the number of people with complex needs accessing mainstream primary care. It has led to new services, such as the new clinic at Wellspring GP surgery. It has also empowered the women involved to act as champions and advocates in their community.

Some of the women involved in Bridging Gaps said:

“I really enjoy working with Bridging Gaps, we are a group of diverse women. Working with Bridging Gaps has given me a real sense of pride and fulfilment, to actually see changes happening because of such amazing and strong women is fantastic. Working with GPs to be more trauma-informed in services is such a vital part of supporting women who have been through so much in their lives.”

“Since the very first day the Bridging Gaps group began, I’ve noticed so much growth and change in myself. At the beginning I’d be anxious to talk and had low confidence. I truly believe we have built a bond over the time we’ve spent together. My growth is astronomical. I would recommend all walks of women having a positive group like Bridging Gaps in their lives…”

The team continues to develop the project. One key learning is that one-off training events don’t always enable an interactive process. They recognise the need to work with GPs in the longer term to be able to make change happen. This has happened with our work with Wellspring. One of the women involved in this work said:

“Working in collaboration with Wellspring has been such a positive experience. I was surprised at how willing they were to work with Bridging Gaps and how seriously they took our suggestions and feedback.”

Dr Hannah Condry, a GP involved in setting up the Open Doors clinic at Wellspring, said:

“We have really appreciated working with the Bridging Gaps team – it’s so helpful to have their energy and enthusiasm. They have challenged us and encouraged us to think in different ways, and I feel so lucky that we have been able to put the ideas we have developed with them into action.

“The regular meetings with the women with lived experience have made sure that we continue to consider our approach and try to improve, rather than just ploughing the same furrow. Now that we have started to run the Open Doors clinic inspired by the women’s ideas, we are seeing how many people had health needs which we were not meeting, and we had not even realised about. Hopefully we are able to make a start on working with them to improve that. We would really like other people to share our learning, and patients at other practices to benefit from it.”

Dr Michelle Farr, Research Fellow at the University of Bristol and NIHR ARC West, said:

“We want the work of Bridging Gaps to go from strength to strength. There are lots of opportunities to expand the work that we’re doing to make sure that healthcare is available and accessible to people who need it most.”