As a PCN we are committed to improving the health outcomes of our community. Working together with our members and feedback from the community we have developed the following purpose, priorities and strategic vision. The strategic vision statement has been agreed upon by all GP surgeries in the PCN. As a PCN we recognise that advocacy, campaigning and collaboration are as essential to improving health outcomes as the work done inside our GP surgeries to shift the dial on health inequalities.
We represent the GP practices of North Lewisham Primary Care Network (PCN). Our PCN covers 80,000 residents across 9 GP surgeries in North Lewisham with some of the worst health outcomes in the borough. As a PCN we are committed to improving the health outcomes of our community. We recognise that advocacy, campaigning and collaboration are as essential to improving health outcomes as the work done inside our GP surgeries to shift the dial on health inequalities. We also recognise that our advocacy has historically been for individual patients and this is not enough and only prioritises those in our community who are engaging with GP care.
Every day in our GP surgeries we see and hear patients struggling with ill health secondary to poverty and other social determinants of health. We have seen an increase in our workload due to an increase of deprivation in our area, first due to cuts to public services but also secondary to the impact of COVID-19.
The National Living
The national living wage is still too low to meet the minimum income standard. We know that earning a living wage is linked to healthy life expectancy and that poverty has the most impact on infant and child health (Marmot, 2020). North Lewisham has a high proportion of young people and ethnic minority residents (PHAST, 2020).
Foodbank usage and in-work poverty has increased locally in line with national trends that show a doubling of people who are in-work and claiming housing benefits (JRF, 2021; Lewisham Health & Care Partners, 2020). Many of our patients struggle to prioritise their health such as routine healthcare or health screening opportunities due to zero-hours contracts and inflexible working schedules and anxieties over missing work.
Housing remains a significant challenge for our residents with many of our patients living in poor quality, unsuitable and overcrowded housing. There is clear evidence of the health impact of worsening existing health problems such as asthma, skin conditions, allergies and poor mental health.
North Lewisham has a high proportion of black and ethnic minority population estimated at around 50% in the 2011 census. Systemic racism in medicine and society leads to poor health outcomes for our Black and Ethnic Minority patients. For example, black women are 5 times more likely to die in childbirth, depression is less likely to be diagnosed in Black patients and COVID-19 disproportionately impacted Ethnic Minority communities (BMJ, 2020).
The need for action on the social determinants of health is not new and numerous reports have highlighted the issues both locally and nationally (Marmot, 2020). Individual initiatives have led to improvements in specific areas but have not resulted in the systems-wide changes required to improve health outcomes.
As individual GPs advocating only for individual patients we are not using our position to support our community as an entirety. This is why as GPs part of the PCN we pledge to work in partnership both locally and nationally with our community for a healthier society and help every resident thrive and meet their potential.
We are working with our community to:
- Put our community at the heart of the decision making regarding service design and strategies to reduce health inequalities
- Building the local economy in North Lewisham as an anchor institution by providing jobs and training/volunteering opportunities for our local community
- Reviewing and improving our services to make them as accessible as possible and hearing community feedback
- To ensure the focus on outcomes in health and care system includes children and young people from conception through to adulthood
- Ensure equal opportunities for those with barriers to care such as language, digital exclusion, disability and inclusion health groups are implemented across the board with early intervention
- Working in a multi-agency approach with our local collaborators and making sure there is a clear leadership and accountability for benefit of the community
- Providing allyship with our community regarding campaigns around the social determinants of health
- Addressing the impact of racism on medicine within our Primary Care Network