Clare Watson is the Health Inequalities Lead for Nottingham West Primary Care Network, with a background in midwifery and a passion for addressing the root causes of health inequality.
Every GP knows the patient who arrives late because the bus didn’t turn up, who nods politely despite not fully understanding, or who simply stops attending because navigating the system feels impossible. We often discuss equity in primary care, but for many practices, it can feel intangible, something written into strategies rather than embedded in reception desks, appointment systems, and consultations.1,2
In Nottingham West Primary Care Network (PCN), we wanted to change that. The PCN Equity Review 2025 was born out of a simple question: what would equity look like if it were treated as routine clinical business rather than a policy aspiration? Rather than producing another strategy document, we developed a practical review tool designed to help practices reflect honestly on how inclusive and accessible their everyday systems really were.3,4
… what would equity look like if it were treated as routine clinical business rather than a policy aspiration?
All practices within the PCN were invited to complete a structured self-assessment using an Microsoft Forms questionnaire. Practices were asked about the tools, processes, and approaches they already used to support patients facing the greatest barriers to care. Crucially, the scoring framework was not shared in advance. This encouraged candour rather than optimisation and shifted the emphasis from performance to learning.
The review focused on six domains that reflect both patient experience and system responsibility:
1. Language and communication support, including interpreting, accessible information, and reasonable adjustments for people with sensory impairment or learning disabilities.3,5
2. Physical and sensory accessibility, covering environmental adjustments and flexible ways of working for people with disabilities, neurodiversity, dementia, or caring responsibilities.5
3. Health literacy and inclusive services, including outreach, advocacy, and flexible appointment models for people in precarious circumstances.1,6
4. Financial and social support, recognising the role of social prescribing, benefits advice, and voluntary sector partnerships in addressing wider determinants of health.2,6
5. Digital and technological inclusion, focusing on improving access while actively mitigating digital exclusion.4
6. Environmental sustainability, aligned with Greener NHS principles and the relationship between environmental and health equity.5
Each domain contained a set of evidence-informed options. Practices received an overall recognition level, Bronze, Silver, or Gold, based on the proportion of measures in place. During the first cycle, a Gold-rated practice asked whether continued improvement could be recognised. This led to the introduction of a Platinum level for practices demonstrating sustained progress and leadership.
Following the review, each practice received a certificate and a tailored feedback summary highlighting strengths, priority areas for development, and practical next steps. The process was deliberately supportive. Practices were offered PCN-level guidance, shared learning opportunities, and the option of reassessment when ready.
So what?
What stood out most was the response from practices. The review generated open, reflective conversations across clinical and non-clinical teams. Because it was locally designed and explicitly non-punitive, it avoided the familiar defensiveness that often accompanies external assessment by bodies such as the Care Quality Commission (CQC).7
Variation between practices was also revealing, not as a problem to be fixed, but as a resource. Many practices were doing innovative work in specific domains while having blind spots elsewhere. Making this visible created opportunities for shared learning and peer support across the PCN.
The recognition framework mattered more than anticipated. Certificates were displayed with pride, not as claims of excellence but as signals of intent. The practice-led introduction of the Platinum award reinforced a culture of ownership and ambition, shifting equity from compliance to commitment.
Most importantly, the review helped move equity from strategy to delivery. Small, practical changes, improving how reasonable adjustments are recorded, reviewing digital access routes, and strengthening links with advice services can have a disproportionate impact on patients most at risk of exclusion. These are changes that do not require major investment but do require attention and consistency.
The process also created something increasingly valuable in today’s system: credible, practice-owned evidence of equity-focused improvement. While the review was not designed as research or audit, it provides a clear narrative that supports conversations with the Integrated Care Board (ICB), the CQC, and local partners.4,6,8
What now?
The Equity Review is now embedded within our PCN’s improvement approach. Practices are supported to progress award levels when they feel ready, rather than being driven through a fixed cycle. Aggregate themes from the reviews are informing PCN priorities and place-based discussions on access, digital inclusion, and sustainability.2,9
Looking ahead, the Platinum standard will continue to evolve, with greater emphasis on leadership and demonstrable impact. There is also clear potential for adaptation and spread. The principles underpinning the review, simplicity, honesty, support, and local ownership, are transferable across primary care.10
This work would not have been possible without the original vision of Dr Paul Scullard, whose leadership laid the foundations for the Equity Review Tool and the culture that allowed it to flourish.
Equity does not require perfection, but it does require structure. By giving practices, a practical way to reflect on how care is delivered, we can move beyond rhetoric and make equity part of everyday general practice.
Examples from practice: equity grounded in community
Across several practices, equity is also advanced through flexibility. Teams routinely override embargoed appointments to accommodate known patients who need to attend with carers or at specific times.
Across Nottingham West, the equity review shone a light on numerous examples where practices have gone beyond access metrics to address the lived realities of their populations. At Eastwood Primary Care Centre, a member of the reception team was supported, within working hours, to establish the Eastwood Memory Café in 2017. Initially, all volunteers were current or former surgery employees. The café has since grown into a thriving independent charity, offering a safe, non-clinical space for people with dementia and their carers. Newly diagnosed patients are gently signposted and supported to attend when they feel ready, reducing isolation and complementing medical care with community connection.
Abbey Medical Centre, serving one of the most deprived areas of Beeston, identified food insecurity as a recurring theme in consultations. In response, the practice established its own on-site food bank, enabling timely, dignified support without the barriers of external referral.
Across several practices, equity is also advanced through flexibility. Teams routinely override embargoed appointments to accommodate known patients who need to attend with carers or at specific times. This personalised approach is underpinned by a weekly multidisciplinary team meeting, ensuring shared understanding and collective responsibility.
Together, these examples demonstrate that equity is often realised through trust, flexibility and sustained relationships, not large-scale programmes, but intentional redesign of everyday practice.
References
- NHS England. The NHS Long Term Plan. 2019. https://webarchive.nationalarchives.gov.uk/ukgwa/20230418155402/https:/www.longtermplan.nhs.uk/publication/nhs-long-term-plan (accessed 13 Feb 2026).
- NHS England. Core20PLUS5 (adults) – an approach to reducing healthcare inequalities. https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5 (accessed 13 Feb 2026).
- NHS England. Equality Delivery System 2022. https://www.england.nhs.uk/about/equality/equality-hub/patient-equalities-programme/equality-frameworks-and-information-standards/eds (accessed 13 Feb 2026).
- Royal College of General Practitioners. Health inequalities: a guide for general practice.
- NHS England. A framework for digital inclusion in health and care.
- Care Quality Commission. Equality, diversity and human rights in health and social care.
- Marmot M, Allen J, Boyce T, et al. Health equity in England: the Marmot review 10 years on. 2020. https://www.health.org.uk/reports-and-analysis/reports/health-equity-in-england-the-marmot-review-10-years-on-0 (accessed 13 Feb 2026).
- Office for Health Improvement and Disparities. Health inequalities: Place-based approaches.
- NHS England. Greener NHS: delivering a net zero NHS. https://www.england.nhs.uk/greenernhs/a-net-zero-nhs (accessed 13 Feb 2026).
- Public Health England, University College London Institute of Health Equity. Local action on health inequalities: improving health literacy to reduce health inequalities. 2015. https://assets.publishing.service.gov.uk/media/5a80b62d40f0b62302695133/4b_Health_Literacy-Briefing.pdf (accessed 13 Feb 2026).
Featured photo by Hannah Busing on Unsplash.
