Primary care networks have the potential to be the drivers of change on health inequalities | Lord Victor Adebowale

Victor Adebowale

Health inequalities have been exacerbated by COVID-19, with the novel virus disproportionately affecting people living in more deprived backgrounds and those from a black and minority ethnic (BME) background. Lord Victor Adebowale, the new chair of the NHS Confederation, reflects on the importance of primary care, and primary care networks, in making lasting change in their communities. 

We are on the cusp of a real opportunity to transform health and wellbeing for all, and especially for those who have for too long been at an unfair and completely preventable disadvantage.

COVID-19 has highlighted the very different experience many of us have in our health and wellbeing. We’ve known for many years that some communities suffer unnecessarily worse health and wellbeing than others. The NHS increasingly acknowledged this and has ensured tackling health inequalities is a key element in plans and guidance documents. But COVID-19 had really brought these inequalities to the fore.

The recently published Public Health England report confirms that the impact of the disease has stayed true to existing health inequalities and in some cases increased them. Men are more likely to die from COVID-19 than women. Those living in deprived areas more likely to die than those living in more affluent areas. And those from a BME background are more likely to die than those in white ethnic groups. 

But it’s not only the risk of death which plays along age-old health inequality lines. Some groups, as a combined impact of COVID-19, circumstances and poverty, will be more likely to experience reduction in income, less likely to secure safe housing, less likely to afford healthy food, less likely to be able to home educate their children and less likely to have the technology to do so. It is direct experience of poverty and an appreciation of access to food through school, that spurred footballer Marcus Rashford to start an inspirational and successful campaign to support low-income families through an extended period without schooling. 

Primary care networks (PCNs) in particular have the chance to make a significant and lasting contribution to the reduction of health inequalities for their populations. They have a new opportunity to change the way they deliver services to support their local communities. They can explore their own data, develop a thorough understanding of the health needs of their populations and redesign services accordingly. They can recruit to new roles, such as social prescribers, to help deliver the new services and to provide their communities with services than go beyond physical health and recognise the importance of taking a more holistic view of people’s health. 

They can ensure that people are seen by the right member of the team, and at the right time. Being at a more local level, they can engage effectively with other organisations working in their patch, such as the community and voluntary sector, secondary care and importantly, local authorities. This latter relationship will help to develop effective collaborations with local councillors, housing, education, social care, economic development and sports and cultural teams. 

But most importantly, PCNs have a new opportunity to engage with their populations and patients, to reconnect and to have the discussion about what they really need, what they can realistically expect and what they can do to stay in the best health possible.

In the words of Dr Mark Spencer, one of the co-chairs in our new PCN Network: 

“PCNS can genuinely empower residents and patients to be at the heart of everything they do. The most effective way of doing this is actively listening to what matters to residents and patients, not just once but on a regular, ongoing basis and by giving them a voice.  People being in control of their own health, their own lives and their own community is a key feature of addressing inequalities.”

Here at the NHS Confederation, we will continue to do all we can to support the NHS in this vital work. We will support PCNs to develop new skills, form new relationships and share good practice with each other. We will encourage other parts of the sector to work with PCNs and embrace the opportunities now present. 

I’m extremely proud that the NHS Confederation is to host the NHS Race and Health Observatory. As an organisation we are committed to supporting our members both as employers and service providers to promote equality, diversity and inclusion and create a fairer health and care system. The NHS Race and Health Observatory will be critical in identifying and helping to transform the disproportionate effects that race is having on patients, communities and NHS staff. This has the potential to be a step-change towards a new era of greater equality.

We will soon be publishing a report on PCNs a year after they first came into existence, looking at the past 12 months and ahead to the next – keep an eye out for this.

And finally, I’d love to hear more about what PCNs are doing to address unfair and avoidable variations in health and wellbeing. If you be happy to have a chat, please drop a line to 

Together, we can make a difference in tackling health inequalities.

Lord Victor Adebowale is chair of the NHS Confederation. Follow him and the organisation on Twitter @Voa1234 @nhsconfed 

Time to reset

The NHS Confederation has launched a new campaign, known as NHS Reset, to contribute to the debate on what the health and care system should look like in the aftermath of the COVID-19 pandemic. Health inequalities form a key focus of the campaign. Find out more on our NHS Reset web section.



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