Health Equity GP Curriculum

In 2017 we conducted a Delphi survey of experts, frontline GPs, and patients to identify the knowledge skills and attitudes required to work in areas of socio-economic deprivation (the deep end). 

This is presented below. We aim to refresh this soon, with a focus on all healthcare professionals and settings. 

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Core knowledge

Background to health inequalities
  • Discuss the social determinants of health
  • Explain the principle concepts of health inequalities, including the inverse care law and inequity vs. inequality
  • Summarise the history and principles of the NHS and demonstrate an awareness of current national and local healthcare structures and politics
  • Discuss differing social norms across populations

Understanding patient groups
  • Describe the challenges and effects of living in poverty
  • Give examples of the common barriers to accessing healthcare for marginalised groups
  • Discuss the impact of adverse childhood events and experiences
  • Describe the prevalent health problems of marginalised groups
Tackling inequality
  • Apply the concepts of health inequalities and social determinants to a local and/or practice population, identifying features and demographics of local community that might impact on health and lead to adverse outcomes
  • Demonstrate awareness of the local health support landscape, including community services to address the needs of patients e.g. health, social, voluntary and third sector
  • Demonstrate competence in the identification and primary care management of mental health problems, including: complex trauma, depression, anxiety, personality disorder and post-traumatic stress disorder
  • Offer primary care management of drug and alcohol problems

Extended knowledge

Extended background knowledge
  • Broadly outline the social/benefits system and what support is available to help patients navigate its systems
  • Outline local and national measures to influence the social determinants of health, including social prescribing schemes
  • Describe the concept of health literacy and its impact on promoting health and delivering care
  • Outline the rights to healthcare of migrants, refugees and asylum seekers

Tackling inequality
  • Identify the unique needs of marginalised groups including ethnic minorities, homeless patients, gypsies/Roma/travellers, offenders, those seeking asylum, vulnerable migrants, those with a learning disability, patients who identify as LGBTQIA, and sex workers
  • Debate the role that health advocacy and activism can play in improving the health outcomes of individuals and populations
  • Identify, support, and direct to help those patients who are suffering social crises e.g. housing or finances
  • Demonstrate competence in the holistic assessment and management of medically unexplained / persistent physical symptoms
  • Discuss the features and usage of common psychotherapeutic interventions, including cognitive therapies, trauma therapy and motivational interviewing

Core skills

  • Adaptable and flexible communication skills
  • Team working
  • Empathy
  • The ability to take a thorough social history
  • Critical thinking
  • Time management
  • Personal resilience
  • Ability to identify and establish boundaries
  • Identifying characteristics of patient populations
  • Flexibility and creative thinking
  • Ability to manage risk
  • Promotion of patient self-care where appropriate
  • Skills to overcome language barriers, including the use of interpreters

Extended skills

  • Leadership
  • Advocacy - both at individual patient level and by influencing systems and organisations
  • Networking
  • Collaboration e.g. with other practices, local services, academic institutions
  • Education e.g. patients and colleagues
  • Basic primary care cognitive therapy
  • Motivational interviewing
  • Prescribing in substance misuse