Healthcare professionals working in socio-economically deprived areas encounter distinct clinical and service-related challenges that stem from inequitable healthcare provisioning and directly affect patient care. 

This module equips participants with a deep understanding of why primary care is different in socio-economically deprived areas, and empowers them with the knowledge, skills and connections needed to thrive.

Participants rigorously examine core topics through a lens of health equity whilst applying theoretical frameworks to their real-world experiences. By doing this as a group of peers it uses collegiality to build confidence and cultivates a network of supported individuals committed to advancing health equity.

Aims:

This module addresses a gap in training and support, and aims to:

1. Enable individuals who work in areas of socio-economic deprivation to better understand and navigate the complex problems existing within these contexts using evidence-based approaches.
2. Equip participants with the ability to apply advanced critical thinking to health equity issues and articulate these challenges in a structured way as part of a change conversation.
3. Enable individuals to develop the knowledge, skills, and confidence to be able to improve their personal clinical practice and apply a health equity focus to their own services as part of strategic re-design.
4. Establish a network of activated, highly skilled individuals with a shared set of values, who can be a resource for creating fairer systems and healthier places.

Available as a standalone module: Yes

Indicative Content:

The module has been designed to cover three elements: 

1. Core knowledge: fundamental concepts relating to health equity.
2. Applied knowledge: application of core concepts to deprivation health topics.
3. Practical skills: for thriving within and changing the ‘deep end’.

Contact hours involve a series of lectures (referred to as sessions, identified in the dates listed above), which have been sequenced to reinforce and build on themes and journey participants through the program.

Main Themes & Session Topics

1. Core Understanding Complexity: Life in the ‘Deep End’
2. Core The Power of Consultations: Empathy in adversity
3. Core Vulnerability: Domains of resilience and social capital
4. Core Dependence: Power imbalances and creation of demand
5. Practical Self-care: Rational choice, behaviour change and allostatic load
6. Core Access: Exclusion, agency, activation, and candidacy
7. Practical Promoting continuity: Relational care in the face of adversity
8. Applied Mental wellbeing: Social the medicalization of unhappiness
9. Practical Advocacy: Power, privilege, and the perpetuation of passivity
10. Core Financial wellbeing: The causes and consequences of poverty
11. Applied Food poverty: The social gradient to diabetes and obesity
12. Applied Living in pain: Pain as the expression of social distress
13. Practical Trauma: Addressing cycles of adverse experiences
14. Applied Last phase of life: Anticipatory care and dying in poverty
15. Applied Data and research: Commissioning and community research
16. Practical Peer support: Building connections between people & places

Each workshop is accompanied by small group tutorials around a themed question or challenge. These topics are circulated as preparation, along with suggested references. The workshops then build on these themes, with indicative content as described below. The module includes embedded ‘forum’ days which cover specific topics in more detail, by visits as part of experiential learning and by action learning sets designed to build peer support.

Session 1: Understanding Complexity

This session introduces concepts such as the ‘Deep End’. It explores the causes of health inequalities and the consequences to frontline staff, specifically focusing on understanding and coping with complexity in clinical settings.

Session 2: The Power of Consultations

This examines how consultations differ in more deprived areas. It explores how socio-cultural factors impact on consultation dynamics and introduces tools to support the development of empathic consulting as a core ‘deep end’ skill.

Session 3: Understanding Vulnerability

This session frames vulnerability through a lens of social capital and explores the ways in which this gets created at individual and community levels to understand how primary care clinicians can identify and support their vulnerable cohorts.

Session 4: Understanding Dependence

This session considers power and control in relation to dependence and how this impacts on service use. It also explores the implications of using service-based approaches as ways of building population health.  

Session 5: Self-care and wellness

This session explores how socio-cultural factors impact on the ability to self-care. It applies theories of behaviour change within this context and explores the use of health coaching as a strategy to improve activation.

Session 6: Access and candidacy

This session explores the association between deprivation and service use. It frames ‘access’ as a process, introduces the concept of candidacy and focuses on health inclusion and care for excluded cohorts.

Session 7: Promoting Continuity

This session explores why continuity of care is of such importance to systems, communities and individuals and considers the role of narrative approaches in areas of socio-economic deprivation, pus barriers and enablers of provision.

Session 8: Mental Wellbeing

This session considers the social determinants of mental health and applies this to the construction and management of common mental wellbeing-related presentations in primary care.

Session 9: Advocacy

This session explores types of advocacy, and considers the relationship between advocacy, activism, and passivity as part of a conversation about change that requires participants to reflect on their own roles as advocates.

Session 10: Financial Wellbeing

The session examines the difference between deprivation and poverty. It covers ways in which poverty is measured, and how the distribution and consequences of income deprivation shape care provision.

Session 11: Food Poverty

The session examines core concepts in food security and uses these to explain the social gradient to diabetes. It considers behaviour change and ways in which solutions to food insecurity can be found within community-led initiatives.

Session 12: Living in Pain

This session explores the link between deprivation and pain. It frames chronic pain as a dysregulation of emotional systems and considers the consequences, including social gradients to prescribing. 

Session 13: Trauma Informed Care

This session explores the relationship between exposure to adverse experiences in childhood and poor health in later life. It outlines the principles of trauma informed care and considers community-based approaches.

Session 14: End of Life

The session explores how social gradients continue to manifest in the last phase of life, not only through reduced life expectancy but also regarding anticipatory care, place of death and the financial impact of dying.

Session 15: Data and Research

This session explores the role of data in driving change. It looks at the history of health inequality research, explores the purpose of equity-related data and considers funding mechanisms, including proportionate universalism.

Session 16: Peer Support

This session examines community-based approaches to health and wellbeing, explores the role of participatory approaches in deprivation healthcare and considers how participants can support each other beyond the course.

Venue: Taught in person at CLCH or community venues.

Typical intake: Starts Semester 1, September intake.  

Career Benefits:

The program has been specifically and meticulously designed to equip and empower participants with the skills needed to perform clinical, leadership and research roles in areas of socio-economic deprivation. 

The dearth of recognised academic qualification in this field combined with the practical nature of this program means graduates will emerge as highly sought-after professionals, with expansive career opportunities across Integrated Care Boards (ICBs), borough councils, Primary Care Networks (PCNs), and various provider organisations, including NHS Trusts and academic institutions. 

With ICBs mandated to tackle health inequalities and a pressing need for qualified professionals, this program not only paves the way for immediate impact in these roles but also serves as a springboard for rapid advancement into senior leadership positions as experience is gained.