Nottingham West PCN has developed a practical review tool to help practices assess how inclusive and accessible their everyday systems really are for patients who face the greatest barriers to care. PCN clinical lead for health inequalities, Clare Watson, explains more.

Serving 110,000 patients across 12 practices, Nottingham West PCN covers Broxtowe, which spans three neighbourhoods often perceived as relatively affluent. But this masks hidden inequalities with pockets of severe deprivation where people experience multiple disadvantages.

Broxtowe faces major public health challenges, including high smoking prevalence and elevated teenage pregnancy rates. With a growing and ageing population, residents also experience earlier multimorbidity and lower-than-average healthy life expectancy.

Every day, we see patients whose health outcomes are affected by factors such as language barriers, disability, low health literacy, digital exclusion, financial hardship and caring responsibilities. While national strategies such as Core20PLUS5 emphasise reducing health inequalities, frontline teams often lack practical tools to translate this ambition into routine practice.

The equity review tool was developed to bridge that gap. Launched in March 2025, it helps GP practices assess how inclusive and accessible their everyday systems are for patients facing the greatest barriers to care.

Aims

The aim was to translate the concept of health equity into measurable actions within everyday general practice. The tool grew out of a simple question: what would equity look like if it were treated as routine clinical business rather than a policy aspiration?

The review provides a framework to identify strengths, highlight areas for improvement and implement practical changes to improve access, experience and outcomes. It also supports shared learning across the PCN and helps demonstrate progress in reducing health inequalities.

In March 2025, all 12 practices within the PCN were invited to complete a structured self-assessment questionnaire using MS Forms. Nine took part.

Practice teams across clinical and non-clinical roles were involved in completing the review, which asks them to identify the tools, processes, and approaches they already use to support patients facing barriers to care.

Method

Based on patient feedback and national guidance, the PCN identified six domains that reflect patient experience and system responsibility:

• Language and communication support

• Physical and sensory accessibility

• Health literacy and inclusive services

• Financial and social support

• Digital and technological inclusion

• Environmental sustainability

In my role as clinical lead for health inequalities, I reviewed the responses and generated a rating - gold, silver or bronze – for each practice, together with feedback on areas for improvement.

Crucially, the scoring framework was not shared with practices beforehand to encourage honest reflection rather than performance-driven responses. This helped shift the focus from assessment to learning and improvement.

Practices also receive a certificate showing their level. I hand-deliver this in a face-to-face meeting to go through the results, discuss recommendations and share best practice from across the PCN. With permission, I also connect practices so they can learn from one another’s strengths.

Benefits and challenges

The low cost is an important feature of the project. The equity review was designed to be delivered through existing PCN leadership and practice engagement. As the main cost is staff time, it did not require additional funding. 

From the initial idea to launch, development took around five to six months of staff time from a small group: Dr Paul Scullard, one of the PCN neighbourhood lead GPs who came up with the idea; our PCN IT, data and information lead; the PCN business manager; and me.

Practices also need to invest time to complete the self-assessment and then review their feedback.

One of the greatest benefits has been the open and reflective conversations the review has generated within practice teams. As the process was locally designed and explicitly non-punitive, it avoided the defensiveness that can sometimes accompany external assessments.

The review also revealed variation between practices. Rather than seeing this as a problem, we used it as an opportunity for shared learning. Many practices were doing innovative work in particular areas while having gaps in others. By making this visible, practices could learn from one another and adopt successful approaches already working elsewhere in the PCN.

Nevertheless, one challenge was ensuring that the review remained supportive rather than being perceived as another performance framework. Emphasising learning, feedback and voluntary reassessment helped maintain a positive improvement culture.

Outcomes

The review has resulted in strong engagement across the PCN. In the first round of assessments, five practices achieved gold, two silver and two bronze.

One of the gold-rated practices asked whether continued improvement could be recognised, which led to the introduction of a platinum level for practices demonstrating sustained progress and leadership. Since then, one practice has progressed from silver to platinum, while another has moved from bronze to gold after reassessment. Of the three practices that did not engage at launch, one is now preparing for its first assessment.

The recognition framework proved particularly motivating. Practices displayed their certificates with pride and used the feedback summaries to guide further improvements.

After using the review tool, practices have implemented a range of practical changes. Many improvements relate to how patients interact with services, such as improving communication support, reviewing digital access routes, increasing flexibility in appointment systems, recording reasonable adjustments and strengthening links with community organisations.

Practices have also highlighted examples where local initiatives have improved patient experience, such as community memory cafés for people with dementia, stronger links with voluntary sector organisations and on-site food support for patients experiencing financial hardship.

Future

The equity review is now embedded within the PCN’s ongoing improvement approach. Practices are supported to progress to the next award level when they feel ready, rather than being driven by a fixed assessment cycle.

So far, we have returned to two practices for reassessment at their request. The decision to seek reassessment rests entirely with each surgery.

This flexibility is one reason the tool works. Some practices are keen to reach platinum quickly, while others are working through their recommendations at their own pace. Some have said they may seek reassessment ahead of a CQC visit so they can demonstrate learning and development. We are happy to re-engage whenever the time is right.

We plan to further develop the platinum standard and expand the sharing of best practice across the PCN. Aggregate findings from the reviews are also being used to inform wider discussions with partners about access, digital inclusion and health inequalities.

The model has clear potential for adaptation across other PCNs and could help other areas move from discussing equity to delivering it in everyday practice. It demonstrates that meaningful improvements can often be achieved through reflective practice and system redesign rather than large-scale investment. 

The PCN was awarded regional champion in the quality improvement category of the NHS Excellence Awards 2026 for its work on the tool.