“A change in the narrative, a change in consensus”: the role of Deep End networks in supporting primary care practitioners serving areas of blanket socioeconomic deprivation

Abstract

ABSTRACT England’s primary care crisis threatens the ability of general practice to play its role in the latest attempts to address the nation’s stubbornly persistent health inequalities. The primary care crisis is particularly acute in areas of blanket socioeconomic deprivation, where need is greatest. Deep End networks of general practitioners (GPs) are being established in the UK, and internationally, in response to the challenges of delivering primary care in deprived areas. As part of the co-creation of a Deep End network in the North East and North Cumbria, in this study we capture the challenges of delivering primary care in socioeconomically deprived areas that, if not addressed, threaten ambitions to reduce health inequalities. We also explore ways in which a Deep End network could support delivery of more effective primary care. In-depth interviews were conducted between September 2020 and April 2021 with 15 practitioners working in Deep End general practices in North East and North Cumbria. We find that the Deep End metaphor is apposite: it is the volume of clinical and social patient need that creates burdens for Deep End practitioners. We also find a severe mismatch between the demands of caring for Deep End communities and the fantasy paradigm that expects GPs to address health inequalities while failing to redistribute resources to areas of greatest need. We identify practitioners’ hopes for a Deep End network that delivers initiatives tailored to patients’ needs, gives a name to their struggles, and advocates for wider healthcare system recognition of deprivation, and a funding formula that recognises need.