Addressing Health Inequalities

SJT Textbook: Addressing Health Inequalities

Addressing Health Inequalities MSRA

This guide covers the strategic domain of Addressing Health Inequalities MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate an understanding that simply opening a clinic door does not guarantee access; you must actively reach out to those who are least likely to come.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Health inequalities are unfair, avoidable differences in health and healthcare between groups, driven by deprivation, discrimination and structural barriers. The NHS uses Core20PLUS5 to make this practical: focus on the most deprived 20% nationally (Core20), locally defined PLUS groups, and five clinical priority areas for adults, with a children and young people version.

In SJT terms, high-scoring actions move from vague concern to targeted, practical change. They use data to identify who is being left behind, adjust clinics and contact methods to reach those groups, and work with communities to design services that people can actually use and trust. They also monitor access, experience and outcomes by deprivation and other key characteristics.

Low-scoring options rely on generic posters, digital-only offers, or “business as usual” clinics that those at highest risk are least able to access. The exam rewards options that show you understand both individual-level equity (for one patient) and population-level improvement (at PCN, trust or ICB level).

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Identify Core20 areas using IMD data and agree local PLUS groups (e.g. inclusion health, specific ethnic groups, people with learning disability).
2. Design outreach that fits real lives: evening/weekend clinics, community venues, walk-in or phone booking, and transport support.
3. Build in barrier-busting adjustments by default: interpreters, AIS-compliant formats, non-digital access, quiet rooms and carer support.
4. Prioritise Core20PLUS groups for high-impact interventions such as hypertension case-finding, SMI physical health checks and asthma reviews.
5. Partner with community connectors and VCSE organisations to co-design, advertise and deliver services in trusted places.
6. Monitor uptake, experience and outcomes by IMD quintile, ethnicity and other relevant factors, not just overall numbers.
7. Act quickly when data show widening gaps: adapt invitation methods, locations or timing rather than blaming “non-attendance”.
8. Escalate structural barriers (e.g. digital-only triage) via governance routes, referencing equality and health inequalities duties.
9. Share learning across teams, celebrating what has worked and refining projects that did not close gaps as expected.
10. Keep clear records of the rationale for targeted initiatives so they are seen as lawful, proportionate responses to need.

Trap options treat inequality work as posters, publicity or future aspirations rather than targeted, barrier-busting action backed by data and community partnership.

💬 MODEL PHRASES (Use These in SJT Logic)

* “We will run this clinic in the community centre with walk-in access, interpreters and Easy Read materials to reduce barriers.”
* “Please report uptake and outcomes by IMD quintile and ethnicity so we can see whether this is actually narrowing gaps.”
* “I will involve local community connectors and VCSE partners to co-design how we advertise and deliver these checks.”
* “Our current online-only system is excluding some groups; I will raise this with the clinical lead and propose non-digital routes.”

Target – Use Core20PLUS5 to focus on those with greatest need.
Tailor – Adapt access, format, venue and timing to remove barriers.
Track – Monitor access, experience and outcomes by group and adjust.

📋 QUICK FAQ

What is Core20PLUS5 in simple terms?
It is an NHS framework for tackling health inequalities: Core20 (most deprived national quintile by IMD), PLUS (locally defined high-risk groups), and 5 priority clinical areas (with separate adult and children/young people versions).

Why does the exam care about data, not just good intentions?
Without stratified data you cannot see who is missing out, whether your intervention works, or whether gaps are widening. The SJT rewards options that measure access and outcomes and adjust accordingly.

Is targeting specific areas or groups discriminatory?
No. Targeting is lawful when it addresses documented inequalities and is proportionate. NHS legal duties explicitly require attention to health inequalities; documenting your rationale is important.

How do community connectors help?
They bring local knowledge, trust and lived experience; they can advise on venues, language, messaging and timing so services are acceptable and used, not just available on paper.

What if the service is under pressure and leadership is cautious about change?
You still have a duty to raise concerns and suggest practical adaptations that can be made within existing resources, such as adjusting clinic times, locations or invitation methods.

📚 GMC ANCHOR POINTS

• Treat patients fairly and respond to their individual needs, including those arising from social disadvantage.
• Work in partnership with patients and communities to improve access and outcomes.
• Raise concerns where systems put groups at risk of poorer care or outcomes.
• Support service improvement that reduces barriers and promotes safe, effective care for all.
• Keep accurate records of decisions and rationales when prioritising or targeting services.

💡 MINI PRACTICE SCENARIO

A PCN audit shows that people from the two most deprived estates are significantly less likely to attend hypertension case-finding clinics, and referrals for early cancer diagnosis from these areas are low. Current clinics run 9–5 at the main surgery with online booking only.

Best action: Develop evening and weekend drop-in clinics in community venues in those estates, with phone and walk-in booking, interpreters and AIS-compliant materials, targeted invitations to Core20 postcodes, and routine monitoring of uptake and outcomes by IMD and ethnicity.
Why: This directly targets Core20 areas, removes predictable barriers (time, venue, digital access, language) and builds in measurement, aligning with Core20PLUS5 and NHS inequalities duties.

🎯 KEY TAKEAWAYS

✓ Health inequalities are avoidable; Core20PLUS5 turns concern into focused action.
✓ Target Core20 and local PLUS groups first rather than relying on generic offers.
✓ Tailor clinics and contact methods to remove barriers in high-need communities.
✓ Track access, experience and outcomes by IMD and other key characteristics.
✓ Work with community connectors and VCSE partners, not just top-down plans.
✓ Escalate structural barriers such as digital-only access and document your rationale for change.

🔗 RELATED TOPICS

* → Providing Equitable Care to All Patients
* → Avoiding Discrimination
* → Accessible Information Standard and Communication Needs
* → Managing Multiple Demands and Service Pressures
* → Community Engagement and Co-design

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

You are a GP partner involved in a hypertension improvement project. Data show low blood-pressure recording and high stroke admissions in the most deprived estates in your PCN. Current checks are offered as pre-booked 9–5 appointments at the main practice, booked online. Attendance from Core20 postcodes is particularly low.

Options:
A. Put up a general poster in the waiting room saying “Blood pressure checks available for all” and keep the current system.
B. Develop evening and weekend walk-in BP clinics in community venues on the estates, with phone and in-person booking, targeted invitations to Core20 postcodes, and interpreters/AIS materials available.
C. Ask reception to “encourage everyone” to book a BP check when they attend for any reason, without using any data.
D. Close the BP clinic for now because demand is “too low” and staff are needed elsewhere.
E. Work with local community connectors and charities to promote the new clinics in trusted spaces and languages.
F. Monitor BP check uptake monthly by IMD quintile and ethnicity and adapt invitation methods if gaps persist.
G. Continue with online booking only but send a single generic text reminder to all registered patients.
H. Delay any changes until the next financial year in case funding becomes available.

Example SJT — Rank 5 (best → worst)

You are helping redesign childhood asthma reviews in your local ICS. Data show that children living in the most deprived ward have higher admission rates and lower review attendance. Reviews currently run as standard daytime appointments at the hospital clinic, booked online, with English-only letters.

Options:
A. Introduce after-school and early evening asthma review clinics in a community hub in the deprived ward, with phone/walk-in booking, interpreters/AIS information, targeted invites and collaboration with school nurses and community connectors.
B. Continue hospital clinics but add follow-up phone calls from a nurse to families who DNA, offering flexible rebooking and exploring barriers.
C. Keep the current hospital daytime clinics but translate letters into several community languages.
D. Ask GPs to “remind families” opportunistically during other consultations, without changing the clinic design.
E. Make no changes this year and hope that national campaigns improve attendance.