Diversity: Overcoming barriers to healthcare

Doctors of the World and Hackney Council for Voluntary Services are working with GP practices to encourage GP registration and provide support and advocacy for people from migrant and refugee communities, signposting these patients to relevant services. Marie Cahalane looks at the project’s origins and how it is working on the ground

City and Hackney CCG’s Innovation Fund was the 2017 winner of the National Patient Experience Award – Commissioning for Patient Experience. The Innovation Fund was devised to identify innovative, non-medical, community-based solutions which could increase people’s social skills and improve their confidence and wellbeing – a new way of working for a CCG. The underlying idea was to create opportunities for people to look after themselves and to make access to health and care services easier.

GP views were represented throughout this process, helping define themes and priorities based on the needs and challenges they faced or saw were faced by their patients. Similarly – and this is a point of interest – registered patients were also involved in the process, again highlighting areas for improvement.

A number of projects were undertaken in partnership with GP practices, one of which brought Hackney Council for Volunteering Services (HCVS) and Doctors of the World together with GPs in the area with the shared aim of providing migrant and refugee communities with the support they need, ensuring they are registered with a GP and that they can access the right services for their needs. This is something of a priority for City and Hackney CCG as Dr Anu Kumar, GP and CCG clinical lead for Patient and Public Involvement – who has been involved in the Innovation Fund from the beginning – explains. “General practice is the cornerstone of healthcare delivery and accessibility to that is of paramount importance for individuals, especially for families,” she says.

Community associations

The project grew out of identified need; HCVS host the Hackney Refugee Forum and it became apparent to them that people didn’t understand the UK health or social care systems – where to go, or how to access it properly. “We were aware of a number of poorly-funded, and even unfunded, black and minority ethnic (BME) groups working in the area and it was to them that people were going for advice. But these groups didn’t necessarily know the answers either because they weren’t linked into the system,” Jackie Brett, director of the communities and partnerships team at HCVS, explains. Jackie and her team registered the issue and decided that, rather than trying to change this behaviour and have people seek advice elsewhere, they would skill up these BME groups so that they understood the primary and secondary healthcare systems better.

Ensuring that the healthcare system is navigable for patients forms the basis of HCVS’ sign-posting training. The initial step was a survey assessing where there was difficulty – what people needed from healthcare services and how people were using them. It was then a matter of educating the BME groups and other such organisations – taking them to hospitals and GP practices and showing them how the health and social care systems work – so they could then offer guidance to those who sought help from them.

General practice is the cornerstone of healthcare delivery and accessibility to that is of paramount importance for individuals, especially for families

Lost in translation

“What we want to do is to provide training for GP practices on managing and understanding people’s expectations. We have different communities who have really different expectations of health services because they have come from countries with health services unlike the NHS,” Jackie says. The focus for Jackie and her team is encouraging a cross-cultural exchange to increase understanding on both sides – educating people on how the healthcare system works here and training clinicians to understand patients’ expectations.

Jackie stresses that it’s not just language that can be a barrier to care – concepts are also important – so, when translating a diagnosis, it’s not just about the English; it’s also about managing expectations that people may have. For example, Hackney has a large Turkish population. The Turkish healthcare system is hospital-centred and Turkish residents are not familiar with the concept of GPs; they consider them to be more junior doctors and have less trust in them. The training offered through the project aims to enhance health awareness and explain to those unfamiliar with the NHS how it works and how it can work for them. Making this relevant to everyone requires the understanding of GP practice staff so the team works with GPs and support staff, such as receptionists, to explain why patients might expect something different, as well as what it is that they expect. The intention is to help with communication.

The sooner we can get people to the right part of the health system, and understanding how it works, the better

An important part of this is ensuring that practices have access to, and can offer, the right information and support, so the project provides signposting information to practices in the area. “If you’re a GP or a practice manager, and you’re aware that a patient has been seen but you’re not sure that they’ve entirely understood what they’ve been told, you can suggest who they can contact,” Jackie explains.

Overcoming health inequalities

“There’s also a great deal of difficulty with people who aren’t registered with GPs when it comes to A&E admissions/encounters,” says Dr Kumar. For the CCG, then, it’s important that they are getting patients as close to healthcare delivery as possible and Doctors of the World helped massively in this, offering training in the form of workshops – for patients as much as for practice staff – again looking to break down barriers to healthcare. This inclusive approach to devising healthcare is championed by the CCG because to ‘co-produce’ in such a way builds independence within teams as people take ownership of the issues. “The process itself met our criteria in terms of the themes we chose to focus on – working together, having confidence in users, involving and listening to patients, building independence and integrating services,” Dr Kumar explains.

A desire to overcome the barriers that exacerbate health inequalities forms the basis of this project – a vision that, Jackie says, the City and Hackney CCG are really working towards. “If patients don’t understand how to contact a GP then they present symptoms late and, perhaps, don’t get diagnosed and this can have a massive impact. The sooner we can get people to the right part of the health system, and understanding how it works, the better,” says Jackie.

Much of what the project covers can be applied to the experiences of any patient – navigating the healthcare system can be difficult even for those born and bred in the UK! For practice managers – and the wider practice staff – being aware of your patients, considering things from their perspective, is an important part of providing the best healthcare. Opening up a two-way communication stream with patients can be helpful in breaking down the barriers to healthcare and understanding where their difficulties lie.

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