2024: Bridging Gaps Case Study | Center for Academic Primary Care

Bridging Gaps aims to improve access to GP practices for people who have experienced trauma and have complex needs. Bridging Gaps was founded by academic GP Lucy Potter, from the Center for Academic Primary Care, University of Bristol, and a group of women from Bristol who have experienced trauma including addiction, homelessness, mental health problems, sexual exploitation, street sex work, domestic violence, and sexual violence, and poverty.

Working with CAPC/ARC West researcher Michelle Farr and professionals from One25, a charity supporting women doing street sex work in Bristol, Bridging Gaps has improved access to primary care.

The Central Liverpool Primary Care Network (CLPCN) Tackling Racial Inequality Working Group (TRIWG) was established in response to the Black Lives Matter movement and the disproportionate impact of COVID-19 on global majority communities. The group is led by GPs, Dr Fiza Salam and Dr Cait Taylor. Social and economic inequalities, racism, discrimination, occupational hazards and inequities in the monitoring of long-term conditions all contribute to health inequalities. Lack of confidence in NHS services and healthcare treatment is also a problem.

CLPCN commissioned Co-create to help them engage their patients in service development and identify and address barriers to healthcare equity.

The analysis, written by people involved in both projects, shares reflections on how to work with communities to co-produce services designed for them:

• How and where to get involved: creating safe spaces (such as Bridging Gaps’ all-female group) and TRIWG’s approach to joining existing services and groups where people already meet
• Trust is crucial: developing relationships requires a long-term commitment on the part of the service provider. People should not be expected to share their trauma and experiences.
• Work with existing groups outside primary care: this can help address power imbalances
• Agree on boundaries: Mutually agreed roles and boundaries should be agreed at an early stage. This should include careful consideration and clear communication around protection and confidentiality

The authors conclude:

“The need for significant support, time, resources and expertise to enable safe participation for those least well served by existing models of care may partly explain why so many voices are currently excluded from the development of primary care services. This is likely to perpetuate health inequalities.

“Our experiences emphasize that co-production is possible, but collaboration is key. To move beyond the PPG, practices need to look to their wider communities and ‘join’ what is already happening.

“As demonstrated in Liverpool, local PCNs’ outreach to community groups can significantly increase participation in service development. Working with Bristol charity One25, Bridging Gaps gained access to people with experience and availability to provide regular support to members of our group.

“As we strive to deliver trauma-informed care, there is a need for dedicated resources and funding so that the patient voice is meaningfully and safely embedded at the heart of future systems change.”

Paper: Tackling health inequalities together – Inclusion health and co-production. Helen McGeown, Lucy Potter, Danny Sherwood, Bridging Gaps group, Jeremy Horwood, Cait Taylor and Michelle Farr. Published in BJGP.

Further information

Center for Academic Primary Care

The Center for Academic Primary Care (CAPC) at the University of Bristol is a leading center for primary care research in Great Britain, one of ten that form the NIHR School for Primary Care Research. It is part of Bristol Medical School, an internationally recognized center of excellence for public health research and education. Follow on Bluesky: @capcbristol.bsky.social, @capcbristol and LinkedIn

About the NIHR

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and prosperity of the nation through research. We do this by:

• Funding high-quality, timely research that benefits the NHS, public health and social care;
• Investing in world-class expertise, facilities and skilled delivery personnel to translate discoveries into improved treatments and services;
• Collaborate with patients, service users, healthcare providers and communities, improving the relevance, quality and impact of our research;
• Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
• Working with other public funders, charities and industry to help shape a coherent and globally competitive research system;
• Funding applied global health research and training to meet the needs of the poorest people in low- and middle-income countries.

NIHR is funded by the Department of Health and Social Care. Her work in low- and middle-income countries is mainly funded through UK Aid from the British government.