Several initiatives addressing the inverse care law have their origins in the University of Glasgow ‘Deep End’ Project and focus on supporting communities of practice in areas of socio-economic deprivation. The Inverse Care Law manifests in patients consulting more yet feeling less enabled after consultations and primary care teams are left more stressed. In some areas both patients and primary care teams breathe the worst air quality in London. Prior to Covid-19 Syndemic (March 2019), an inclusive, formative social movement for health equity was facilitated in North West London, drawing from the ‘Deep End’ Project, which had started to deliver a curriculum linked to a change program.
The combination of the disproportionate impact of Covid-19 in the North East London community and the Black Lives Matter movement prompted a small group of leaders from the RCGP NEL Faculty to own the problem and respond to longstanding structural racism, deprivation, and exclusion. Leaders with values of social justice felt isolated, powerless, anxious, and hopeless. There was a loss of trust in the system at every level. The leadership task was to share ownership of the pre-existing problems of racism, deprivation, and the impact of Covid-19.
Six local leaders connected to facilitate a supportive safe, space for others to share support and information on WhatsApp. Using the virtual connecting opportunities offered by the Covid-19 Syndemic, local healthcare leaders could start to focus on advocacy. The initial team was a group of leaders from the RCGP North East London (NEL) Faculty who connected with other local leaders in NHS organisations (NHS Integrated Care Systems, NHSE, HEE) and the medical school (QMUL). The target group were local leaders and activists from primary care, community health and the third sector with shared values around social justice and health equity.
There was an appreciation of the allostatic load , moral distress, loneliness, loss of trust and perceived helplessness of those working in areas of deprivation. The WhatsApp platform was an easy, quick way to connect, exchange information and share dialogue. The goal was to promote a culture of support, inclusion, and belonging for GPs and teams, and to move to a Syndemics narrative to understand the impact of Covid-19 and structural racism and exclusion. This involved integrating environmental, social, and medical causation with a vision of health equity (Marmot Informed) through climate health creation for fairer systems and healthier places.