Health inequalities and silver linings

22 May 2020 

In all the sadness and challenges that the COVID-19 pandemic has created for us all, in our personal and professional lives, I have been keen to grasp the silver linings as they emerge.

And there have been silver linings for general practice, and the NHS.

I think we would all agree that we would wish as much potential good to come from this chapter in history as possible.

Last week, I was asked to deliver a webinar as part of the Royal College of Physicians of Edinburgh COVID-19 series, which is available to listen to, and for the next few weeks’ blogs, I thought I would share some silver linings with you, with updates along the way.

Recognising the role of the NHS for the socially vulnerable

Throughout the pandemic, there has been much focus, appropriately, on the medically vulnerable in the context of COVID-19, allowing them to be targeted for additional medical and social support.

More recently a spotlight has been shone on the socially vulnerable who are often more “hidden” in the context of COVID-19.

Figures from the National Records of Scotland released at the start of May show that those living in the most deprived areas were 2.3 times more likely to die from COVID-19 than those in the least deprived communities.

There are many reasons for this (a blog in itself) but I am determined that the crucial role that general practice plays (in partnership with public health) in mitigating against the predicted further worsening of health inequalities is recognised and resourced.

The predicted economic downturn that we will see as lockdown eases will mean that those who were struggling before with the effects of poverty on their health and wellbeing will struggle more, and this will be felt in every single practice across the country.

A compassionate road to recovery

So where is the silver lining here, you may be thinking?

I believe that the increased levels of public awareness around the plight of the most vulnerable offers us a compassion window of opportunity for action and a catalyst for change.

Both the professions and politicians have a part to play in ensuring that beyond COVID-19, our NHS is best where it is needed most – otherwise health inequalities will worsen.

This has to underpin all of our recovery planning for the NHS.

The pandemic's impact on health inequalities

I am delighted to have been asked to help lead on health inequalities work for the RCGP at a UK level, and will work in close partnership with my inspiring colleagues from the RCGP Health Inequalities Standing Group and the GPs at the Deep End Group.

I had the opportunity to kick-start this work with an interview with Professor Sir Michael Marmot earlier this week, reflecting on the:

  • impact of COVID-19
  • potential role of general practice and of the RCGP
  • global lessons we should learn
  • next steps.

It was a great conversation, offering clarity on how we can most effectively impact on mitigating health inequalities, underpinned by the evidence.

This has been recorded for the new health inequalities section of the RCGP COVID-19 resource hub which should be up and running soon.

Mitigating the worst effects on health inequalities

There will be many strands to this health inequalities work, including:

  • the development of practical resources for GPs
  • a planned webinar next month
  • the creation of a thought piece to stimulate further discussion and engagement.

The previously launched Health Inequalities vlogs and FAQs will also soon be available on the health inequalities section of the hub site.

In my own practice, we have used the suggested approaches in this resource in our outreach telephone calls to the most socially vulnerable patients on our list.

This work has been led by our practice care coordinators, who have found it both rewarding and humbling.

There have been five-minute check-in calls about:

  • food security
  • housing security
  • personal security

Of these, 80% of calls resulted in an onward 'referral' to food banks, welfare advisors or a clinician.

Our patients, many of whom are isolated and frightened, were delighted to have been contacted, highlighting the very important role that we play in providing healthcare in its widest sense.


Post written by

Dr Carey Lunan, Chair RCGP Scotland

Dr Carey Lunan is a GP partner in one of Edinburgh's Deep End practices and is the current Chair of RCGP Scotland.

Prior to this, she held the role of Executive Officer for Patients and Public and Interface working. She also sits on the RCGP Ethics Committee.

Her priorities during her time as Chair include a focus on practitioner wellbeing, improving the interface between primary and secondary care, and growing and retaining the GP workforce.

She has made tackling health inequalities a high priority and has consistently called for the need to engage the public in a national conversation about the realistic role of the modern NHS and the importance of collective social responsibility for its use.

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