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The inverse care law is still alive and kicking, says Prof Mike Holmes in his latest blog, describing how the NHS vaccination programme is adapting to health inequalities

The coronavirus pandemic has, without doubt, been a challenge for everyone in society. One of the most sobering aspects of it, for me, has been that risk it poses has not been the same for everyone in society.

We have seen that there is higher risk or serious illness and death in less affluent populations, in ethnic minority communities, amongst older members of society and for those with coexisting medical problems. In fact, could it more accurately be referred to as a syndemic (google it!) – a situation where two or more epidemics interact and create a worse outcome for those involved? A coronavirus epidemic and an epidemic of health inequalities.

We have seen the vaccination programme adapt to this by targeting older people first as well as those long term medical conditions – we have seen that make a huge difference and weaken the link between infection, hospitalisation and death. We have however also seen uneven take up of the vaccine. We have worked with our public health colleagues to meet the city’s needs and taken vaccine clinics wherever they have been needed – a solution that has been able to deliver a high volume of vaccinations in parallel with a flexible solution that has responded to need has served us well. We will continue this approach as we move into the autumn booster programme.

This week we have seen Professor Chris Whitty’s report on health inequalities confirming what we have known for a long time in the across our region. That the inverse care law is still alive and kicking. Our less affluent, coastal communities have worse health outcomes and find it harder to recruit a full complement of staff. He said if we don’t tackle the health problems in these communities, things will get worse. But tackling them is not easy – it will require huge investment in infrastructure, schools, workforce and transport links.

I feel so privileged to be part of a practice at Haxby Group, who alongside other practices, have taken a step to support the health care community in some of these areas.

We have both opened new practices as well as supported existing practices in Hull and Scarborough. Our experience has shown how difficult it is for all elements of health and social care to work in these communities. It is going to require ongoing and innovative efforts to build the required workforce, it is going to require us to work differently and use technology to support the effort. It may be difficult to believe but our practices York have greater resources that those in Hull – we published our experiences in the British Journal of General Practice last October – we will continue to raise this at the highest level until the balance is redressed.

Nimbuscare is also talking to practices on the coast and are keen to share the learning we have taken from working at scale during the pandemic in York. As we move to working in an integrated care system across Humber, Coast and Vale it will become more important than ever to support each other and essential that we start to work as a system rather than individual sectors to provide the right level of care to everyone in society.

It has always amazed me that GP Practices across the UK see and treat around one million people every day - around 85% of all health interactions in the NHS happen in General Practice. Yet General Practice only receives around 11% of the NHS budget. The vast majority of NHS funding goes to acute health services within our hospitals. Any vision of the future NHS must ensure that the NHS cost effectiveness is maximised – the economic impact of the pandemic will be felt for years – I don’t think we can allow healthcare to suffer as we recover.

As Chris Whitty says, things have to change.

Currently we are seeing a huge surge in demand across the whole of health and social care – we are seeing long hospital waiting lists and people waiting longer for routine GP appointments. This requires immediate action – the system must work together and it will require investment and understanding as we move forward.

We are poised to make progress in York building on the good work that has already happened. I can speak from a General Practice perspective and I am seeing that

  • We are introducing new digital technology and patient management systems so patients can contact us online and we can receive more data on their needs.
  • We are recruiting a multi-professional workforce – paramedics, advanced practitioners, physios, mental health specialists, clinical pharmacists etc – to create more capacity and enable doctors to see patients with more complex issues.
  • We have created an ‘at scale’ organisation (Nimbuscare) which can run services on behalf of GP practices when it makes sense to do so such as the Covid vaccination service, the Covid 19 single point of access hub and Improving Access services. The hope is that through this organisation we can work with the Hospital and the Council to deliver care differently and collaboratively.
  • We are training and developing staff so they take on new skills. This means they have the right skills for our patient’s needs such as care navigators who will help you access the right care, from the right person and the right time.

One could argue that as we continue to struggle with coronavirus that now is definitely not the time for embarking on wholescale system within the NHS. However our politicians seem determined that it will happen. I am worried about what that might mean for the services we provide for patients but as ever, if required, we will throw ourselves into it and make it work. Services are stretched, clinical, managerial and administrative staff are exhausted, our patients’ needs seem to be growing but if we must adapt to another NHS organisation then so be it – as ever, if we can work together, listen to each other and understand each others’ challenges then maybe, just maybe we can get through this too.


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