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Reducing health inequalities through general practice

Michael Heath / Alamy Stock Photo

This article, published in The Lancet Public Health, provides findings from a Realist Review of interventions that influence health and care inequalities in general practice.

Although general practice can contribute to reducing health inequalities, existing evidence provides little guidance on how this reduction can be achieved.

The authors conducted a realist review by searching MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library for systematic reviews of interventions into health inequality in general practice. They then screened the studies in the included systematic reviews for those that reported their outcomes by socioeconomic status or other PROGRESS-Plus categories.

159 studies were included in the evidence synthesis. Robust evidence on the effect of general practice on health inequalities is scarce. Focusing on common qualities of interventions, the authors found that to reduce health inequalities, general practice needs to be informed by five key principles:

  1. Involving coordinated services across the system (ie, connected)
  2. Accounting for differences within patient groups (ie, intersectional)
  3. Making allowances for different patient needs and preferences (ie, flexible)
  4. Integrating patient worldviews and cultural references (ie, inclusive)
  5. Engaging communities with service design and delivery (ie, community-centred).

Future work should explore how these principles can inform the organisational development of general practice.


Anna Gkiouleka, Geoff Wong, Sarah Sowden, Clare Bambra, Rikke Siersbaek, Sukaina Manji, Annie Moseley, Rebecca Harmston, Isla Kuhn, John Ford, Reducing health inequalities through general practice, The Lancet Public Health, Volume 8, Issue 6, 2023.