The area – which includes Deptford and New Cross – is vibrant and diverse, but also experiences much deprivation, health inequalities and social exclusion. This has led to a low male life expectancy, high rates of childhood obesity and relatively low rates of health screening and uptake of the COVID-19 vaccine.
Aware of the situation and the challenges it presents, in March 2021, the PCN started to adopt innovative approaches to how it engages with the community with a desire to implement substantial change. This was in response to the COVID-19 pandemic and the low vaccination rates that were affecting the non-white population in particular.
The PCN performed rapid engagement and a review of existing health inequalities research and found three causal themes:
These themes are echoed in the Birmingham and Lewisham African and Caribbean Health Inequalities Report (BLACHIR) published March 2022 and have been documented in multiple previous engagement rounds and well as nationally in the Marmot reviews.
Current workstreams include: A community forum co-producing initiatives to tackle health inequalities with the local community; hiring a community link worker; improving access to GP services; developing a data strategy to identify and proactively manage residents at risk of health inequalities and prioritised health checks targeting this population.
Dr Aaminah Verity is a local GP and North Lewisham PCN Lead for Health Inequalities. For Dr Verity, two-way conversations with the community are vital for successful outcomes.
She says: “We’ve listened to people in the area, and they gave us ideas and solutions, such as employing a community link worker. Many people in the area are from a non-white background and there has been a historical mistrust of officialdom, so getting people involved is important.”
Dr Verity, who has worked in the borough of Lewisham for eight years, feels that this approach had significant benefits during the height of the COVID-19 pandemic.
“The community led pop-up COVID-19 vaccination clinics were particularly successful,” she says. “It’s difficult to quantify, but the people who were attending were different to those attending the much larger vaccination events such as the Millwall Football Club event held in July 2021.”
She adds: “We found that those attending were included older, ethnic minority people and also undocumented migrants.”
The establishment of a community forums, where local residents and the PCN have come together, has also enabled the community to have its voice heard.
A visual artist has been present at the forums, translating ideas into pictures that cover themes such as GP access, long-term health conditions, poverty, the urban environment, and mental health.
The establishment of community link worker has also created a link between local residents and the GP practices of the PCN.
“Our link worker has been making links with community organisations,” says Dr Verity, “and pulling in different organisations, making sure that we all work collaboratively on initiatives such as Menopause Day and International Women’s Day.”
The PCN’s collaborative and inclusive approach, and establishment of a two-way dialogue has led to the establishment of clear purpose, priorities and strategic vision. The strategic vision statement has been agreed upon by all GP surgeries in the PCN.
The PCN’s approach was presented at the Lewisham Health and Wellbeing Board, and the NHS South East London CCG equalities board and governing board.
Dr Verity says: “Tangible outcomes sometimes take a long time to materialise, but the main point is that we’re trying a different approach, encompassing all people in the PCN area, from conception to end of life.”
She adds: “And another key factor is that our work has been resourced – our team is paid to think and act on health inequalities. The system – the NHS – has been accepting of us trying something new without demanding the metrics beforehand.
“So far, the anecdotal feedback that we’ve received has been very positive, which assures us that we’re heading in the right direction and making a positive and sustainable difference.”
Martin Wilkinson is a Borough Director of South East London ICS.
He says: “The COVID-19 pandemic clearly illustrated the consequences of health inequalities and the profound effect on the non-white population.
“And this inequality manifests itself beyond the presentation of infectious disease, extending to diabetes, heart disease, obesity and mental health, among other conditions.
“That’s why the work carried out in North Lewisham by the PCN, in line with the ground-breaking BLACHIR report is challenging the status quo.”
He added: “Health inequalities can be recognised and tackled – and we want to see the work of the PCN replicated across the whole of the borough and are investing in this and other interventions through the Health and Wellbeing Board’s two-year health equity programme.
“We also want other London boroughs to learn from Lewisham’s experience and draw positive conclusions that will make a real difference to the capital’s diverse communities.
“The transition from CCG to ICS will enable us to take this great example of work forward, and we are looking forward to seeing a sustainable positive impact.”