Addressing health inequalities in Nottingham and Nottinghamshire: improving access through new models of primary care

Project Title: Addressing health inequalities in Nottingham and Nottinghamshire; improving access through new models of primary care

Deadline: 12 noon,15 December 2023

Host University: The University of Nottingham

School/department: Nottingham University Business School   

Start date: 03 April 2024

Working hours: Full-time (minimum 37.5 hrs per week), or part-time (minimum 20hrs per week). 

Working Style: Primarily in-person at host university. Flexible working supported. Working pattern to be agreed between successful candidate and lead supervisor. 

Supervisors

• Lead Academic Supervisor: Dr Simon Bishop, UoN
• Academic Co-Supervisor: Professor Jayne Brown, NTU
• Community Supervisor: Dr Adele Cresswell, Nottingham City GP Alliance

About The Project

Access to primary care services is crucial in addressing health inequalities across communities. However, primary care in the UK is currently facing critical threats to sustainability, including extreme difficulties in recruiting and retaining clinical staff. Vacancies are at historically high levels and there is growing use of expensive locums, bank staff and trainees.    

This problem is particularly acute within areas of high socio-economic deprivation. This compounds disadvantage as a lack of established care teams and services in these areas can lead to reduced quality of health and care as well as inconsistent uptake of new clinical evidence. Across Nottingham and Nottinghamshire, there are significant avoidable and unfair differences in the health and well-being of groups and different areas of the city.   

However, within Nottingham, an innovative model of primary care is being developed to address these challenges. Elements of this model include direct employment of general practitioners at the area level, developing new career pathways for clinicians that reward working in more socio-economically deprived areas, new approaches to building the multidisciplinary primary care team, implementing evidence around severe and multiple disadvantages, and tying primary care closer to the research and knowledge infrastructure. While teaching hospitals have often had close relationships with universities, with benefits for staff and patients, this has traditionally not been the case in primary care.  

This project will take an action research approach, working with Notts GP Alliance to address the challenge of health inequalities in Nottinghamshire by investigating the innovative approaches to primary care development emerging in the region. This research looks to engage with primary care stakeholders to evaluate the emerging Nottingham model of primary care. In doing so, it is intended to support general practice and primary health care in underserved communities within the region. This project is also intended to bring attention to this work at the national level acting as a catalyst for wider change. 

Project Aims

The broad aims of this study are:  

1. To identify current challenges to the viability of general practice in socio-economically disadvantaged areas, examining how these challenges are shaped by the regional circumstances of Nottinghamshire and the broader region.  

2. To develop an understanding of the innovations of primary care organisations that are being adopted in Nottingham and Nottinghamshire to address these challenges.   

3. To analyse the impact of these innovations on improving the viability of general practice in disadvantaged areas, and identify routes for the wider implementation of successful innovations 

Competencies 

Co(l)laboratory Core Competencies
Category	Competency	Assessed: Application (A), Interview (I)
Comprehension and evaluation	Strong understanding of the project and its subject matter.	A / I
	Analytical, researcher mindset with keen attention to detail.	A / I
	Communicate complex concepts with clarity and precision.	A / I
	Able to identify connections, patterns, gaps, and irregularities in information/data.	I
	Able to interpret data/information confidently with logic and empathy to derive meaning.	I
Social and emotional	Demonstrable experience of responding effectively changing contexts, information and demands.	A
	Ability to persevere in the face of challenges/failures and to remain constructive in developing solutions.	A
	Demonstrable passion for learning with clear drive and curiosity to undertake this specific research project.	A / I
	Willingness to immerse oneself in the research subject matter and make a contribute to new knowledge through a PhD.	A / I
	Strong desire to make a positive community impact through the research.	A / I
	Willingness to think deeply about complex concepts and engage with academic ideas and theory.	A / I
Preparedness and potential for success	Experience of working, collaborating and communicating effectively with different stakeholders.	A
	High level of self-motivation and ability to work with minimal guidance.	A / I
	Strong organisational and time-management skills with the ability to balance and prioritise multiple tasks.	A / I
	Ability to identify potential challenges and complexities and thoughtfully consider possible solutions.	A / I
	Able to identify the technical, personal, or professional skills required for a task and take action to develop these.	A / I
Community Context	Genuine desire to undertake community-engaged research over more traditional approaches to research.	A
	Understand the impact of and need for the inclusion of diverse experiences and points of view in research.	A / I
	Appreciation/understanding of the importance of community insight and experience in the generation of new knowledge.	A / I
	Awareness/understanding of the broader societal context related to the subject matter of the project.	A / I

	Project Specific Competencies
Essential	Assessed: Application (A), Interview (I)	Desirable	Assessed: Application (A), Interview (I)
Background or experience in a relevant academic, professional or community setting.	A / I	Experience working across organisational boundaries with diverse professional and public groups.	A / I
Motivation to engage in primary care development.	A / I	Knowledge of the social determinants of health and health inequalities.	A / I
Experience working with diverse groups of people.	A / I	Knowledge of health and social scientific ideas related to organisational change	A / I
Understanding of the broader contextual landscape of healthcare and health inequalities.	A / I	Knowledge of qualitative research methods.

Reference for Further Reading 

1. Anderson, M., O’Neill, C., Clark, J.M., Street, A., Woods, M., Johnston-Webber, C., Charlesworth, A., Whyte, M., Foster, M., Majeed, A. and Pitchforth, E., 2021. Securing a sustainable and fit-for-purpose UK health and care workforce. The Lancet, 397(10288), pp.1992-2011. 

2. Appleby, J., 2019. Nursing workforce crisis in numbers. BMJ: British Medical Journal, 367, pp.1-5. 

3. Battilana, J., 2006. Agency and institutions: The enabling role of individuals’ social position. Organization, 13(5), pp.653-676. 

4. Beech, J., Bottery, S., Charlesworth, A., Evans, H., Gershlick, B., Hemmings, N., Imison, C., Kahtan, P., McKenna, H., Murray, R. and Palmer, B., 2019. Closing the gap. Key Areas for Action on the Health and Care Workforce. 

5. Bishop, S. and Waring, J., 2016. Becoming hybrid: The negotiated order on the front line of public–private partnerships. Human Relations, 69(10), pp.1937-1958. 

6. Campbell, D., (2022) ‘Britains biggest chain of GP Surgeries accused of profiteering’ The Guardian, 13/06/2022 

7. Francetic, I., Gibson, J., Spooner, S., Checkland, K. and Sutton, M., 2022. Skill-mix change and outcomes in primary care: Longitudinal analysis of general practices in England 2015–2019. Social Science & Medicine, 308, p.115224. 

8. Lockett, A., Currie, G., Waring, J., Finn, R. and Martin, G., 2012. The role of institutional entrepreneurs in reforming healthcare. Social science & medicine, 74(3), pp.356-363. 

9. McDonald, R., Checkland, K., Harrison, S. and Coleman, A., 2009. Rethinking collegiality: restratification in English general medical practice 2004–2008. Social science & medicine, 68(7), pp.1199-1205. 

10. McDonald, R., Harrison, S., Checkland, K., Campbell, S.M. and Roland, M., 2007. Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study. Bmj, 334(7608), p.1357.  

11. Merriam, S.B., 1998. Qualitative Research and Case Study Applications in Education. Revised and Expanded from” Case Study Research in Education.”. Jossey-Bass Publishers, 350 Sansome St, San Francisco, CA 94104. 

12. Nussbaum, C., Massou, E., Fisher, R., Morciano, M., Harmer, R. and Ford, J., 2021. Inequalities in the distribution of the general practice workforce in England: a practice-level longitudinal analysis. BJGP open, 5(5). 

13. Owen, K., Hopkins, T., Shortland, T. and Dale, J., 2019. GP retention in the UK: a worsening crisis. Findings from a cross-sectional survey. BMJ open, 9(2), p.e026048. 

14. Razai, M.S. and Majeed, A., 2022. General Practice in England: The Current Crisis, Opportunities, and Challenges. The Journal of Ambulatory Care Management, 45(2), pp.135-139. 

15. Smith, J., Parkinson, S., Harshfield, A. and Sidhu, M., 2022. Early evidence of the development of primary care networks in England: a rapid evaluation study.