GPAW was an eighteen month programme funded by NHS Kensington and Chelsea and NHS Westminster. It developed the BME Health Forum's previous work on access to primary care and was designed to demonstrate practical measures which would improve access to primary care health services for people from BME communities in the two boroughs.
The report identifies a number of key successes and challenges in delivering this programme. It makes recommendations about what commissioners, providers and community organisations can do to improve the experience of healthcare for BME residents.
The assessment undertaken at the start of the programme confirmed that a significant number of BME service users continue to face barriers to equal access to health services. They are dissatisfied with mainstream services which they perceive as lacking in understanding and consideration. This situation can result in poorer health compared to other groups, with unnecessary visits to Accident and Emergency Units, higher rates of hospital admission, and the likelihood of more complex, intrusive interventions at a higher cost.
The Programme developed:
An Interpreting Guide for communities which was complemented by an Interpreting Guide for staff produced by NHS Westminster. Both guides were distributed to community organisations, GP practices and dental practices.
Fact Cards explaining NHS Services in six community languages which were distributed to community organisations.
Case Studies, Cultural Brokerage and Health Information
The one-to-one work between the Access Facilitators and the clients demonstrates that there are still considerable difficulties between a significant number of BME patients and clinicians caused by mutual misunderstandings. The Access Facilitators were able to resolve some of these problems by a variety of methods, including providing information, making appropriate appointments, requesting interpreters, completing forms and generally negotiating and advocating on behalf of patients. This service was very successful as 94% of respondents reported that they received help to resolve an issue they had with the health service.
The success of this work supports the use of cultural brokerage. The Access Facilitators were successful in their work because they were able to negotiate between two cultural systems –their community and the NHS. The Access Facilitators also ensured that clients were not just passive recipients of help but were given the tools and information to advocate for themselves whenever possible.
Action to reduce barriers to effective communication remains key to improving the health experience of BME communities and addressing persistent health inequalities. Interpreting provision needs to be of high quality, better regulated, and more widely disseminated to service providers and communities. There needs to be a greater emphasis on health education in culturally appropriate and user friendly formats. BME communities need to learn the language of health which will empower them to communicate to speak up about their conditions.
Additionally, our experience of the successes and shortcomings of the programme leads to a core set of recommendations for a significant change to the way that primary care services are commissioned. Such change will lead to effective engagement and produce sustainable and long term improvement.
All stakeholders should work together to implement a model for the governance of primary care services which is based on the Canadian Community Health Centre (CHC). This should, in the first instance, be led by the Primary Care Trusts (PCTs) and Practice Based Commissioning Groups (PBC) in the context of their programmes for the development of community based services.
In addition to developing a Community Health Centre (CHC) model commissioners should ensure BME communities are actively involved in all service developments, at all stages from inception to evaluation. This will help demonstrate World Class Commissioning competencies and meet Public and Patient Involvement requirements and Equalities Duties.
Stakeholders should use a community development approach for engagement with BME communities. This will include providing appropriate resources for:
Dialogue with community organisations, particularly around difficult to engage issues;
Dissemination of key health messages;
Close partnership with community organisations in the delivery of preventative services, including screening services and procedures;
Recognising the importance of actively engaging children and young people as key stakeholders in promoting good practice.
Commissioners should adopt a cultural brokerage approach and support community organisations to develop the skills and capacity required to deliver this effectively.
BME Access Facilitators should be recruited and co-located in GP surgeries and community organisations with the remit to educate and support communities and health professionals. This will facilitate greater access, improve communication and increase understanding.
To ensure BME communities and health professionals continue to benefit from the output of the GPAW project, there needs to be:
A commitment from the two PCTs and other key stakeholders to reprint, disseminate and embed use of the interpreting guides and fact cards;
A commitment to produce the GPAW literature in other community languages, in addition to the six included in the programme.
Based on the success of the existing course, ESOL for health should be continued and extended to improve health literacy. This model needs further development to spread and sustain good practice.
Commissioners and the BME Health Forum should work in partnership to develop a training package for commissioners and providers. Training should focus on how best to support and develop community organisations in addressing barriers to health access and resulting health inequalities. This package should incorporate:
The barriers to equitable access;
The link between barriers to access and health inequalities;
Best practice in the approach to supporting community organisations to address these barriers;
The role of cultural brokerage in reducing barriers.
Second tier community and voluntary organisations should be funded to provide additional infrastructure support to BME communities and community voluntary organisations, in order to work in collaboration and promote partnership to address shared health and social issues. This will support community cohesion and increase the capacity of groups who often have a common purpose. There would also be a less burdensome transactional cost involved if community groups could work as a consortium when submitting funding applications in the current uncertain economic climate.