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What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

We are key members of our integrated care system (borough partnership), which aims to mobilise the assets within our local community and in turn improve the health and wellbeing of local residents. During lockdown, one of the key outcomes of the partnerhsip was the forging of relationships between health organisations like ourselves and third sector organisations who have stepped in to support our response to covid-19. These include a sats probe delivery service staffed by volunteers and support of our hub based flu vaccination clinics which we are running for the first time this year.  The volunteers in many ways represent the communities we serve and so are ideally placed to support patients who struggle to get the most out of their interactions with primary care, either because of a language barrier or poor health literacy.

What does your project aim to achieve?

The aim of the project is to identify patients who are known to primary care whose first language is not English (and belong to a particular community prevalent in our local area), and to match them with health advocates from voluntary organisations who speak their language and can support them to get the best out of their consultations in both primary and secondary care. Patients can contact their advocates both before and after GP/ hospital appointments.

The role of the advocate would be to help the patient identify what they wanted to get out of any given appointment, to help them write a list of questions or concerns (if relevant), to support them with goal setting with respect to management of their long term conditions and empower them to self manage to the best of their ability.

How will the project be delivered?

We will work with local practices interested in providing advocacy to their patients from BAME communities.

We will ask them to identify patients with long term conditions whose first language is not English, who would benefit from a health advocate. This identification can be done electronically using EMR but GPs may also know patients that struggle to get the best from their health appointments due to a language barrier +/- poor health literacy.

We will offer to match patients with volunteer health advocates who can support these patients with their healthcare appointments on an ad hoc basis. The volunteers would be briefed and trained on what this support would look like –  identifying what matters most, goal setting, supporting with compliance/ self-management.

Evaluation would include qualitative feedback, appointment attendance data, long term conditions parameters in the longer term.

How is your project going to share learning?

Health inequalities is very topical, but very few interventions have been trialled within healthcare to address these inequalities. We believe this pilot will provide valuable learning about the real life implications of using advocates from within communities to enhance both patient experience and patients outcomes. If successful, this model could be widely adopted for use in both primary and secondary care. There will be iterative learning from the process which will largely be focused on understanding how the model best works, what  ‘good advocacy’ looks like, and in what settings it’s most effective. We will also explore the implications of scaling up, it the desired impact is seen in terms of improved patient experience/ improved self management/ improved health outcomes.

How you can contribute

  • Evaluation - to understand how best to evaluate impact/ if patient reported outcome measures might be relevant
  • Partnership - with a local trust for scale up into secondary care
  • Voluntary sector feedback - to give feedback on feasibility, and help identify any risks we might be overlooking


  1. Hi Rammya and all,

    It might be worth letting the 77 people in Josephine Ocloo's 'PPI & Diversity' SIG know about the project?


  2. This is a great project. I wondered if you had explored with some of the people who might access this support, what good would look like for them and whether GP practices could benefit from hearing the stories captured through this of what has worked well and what remains a challenge?

  3. Hi

    This looks like a really interesting project, I like the idea of having trained advocates to support people to access primary care. A group of us are developing a project to also address health inequalities within primary care, but with a different focus: training GPs to be better equipped when working with people who may have experienced trauma. Women with lived experience have been trained in trauma-informed care principles, and are co-delivering training with GP trainees, pleas see:

    There could be good opportunities to share learning between projects.

    All the best with the project development

  4. Hi all,

    I really like this idea and very keen to support primary care colleagues working with communities to reduce health inequalities.  I wonder if advocacy may also help identify and support citizens who feel digitally excluded but who are also fearful of face-to-face contact in the current situation?

    Evaluation - I think understanding how advocacy affects the experience of patients, advocates and healthcare professionals will be key alongside process measures of frequency of attendance (virtual/ physical), appointment length and appointment/ health outcome.  Obtaining consent for evaluative interviews would add an additional layer of insight and learning.

    It looks like you're not asking for any funding, unless I've misunderstood?  Maybe funding could support the evaluation?

    Good luck!

  5. Hi All,

    Myself and my colleague Emma Adams (Health Transformation Partnership) are supporting the Health Foundation this year by fostering conversations between Q members and encouraging collaboration. We were Exchange applicants last year, so we’re hoping that our experience will help us to help others, as their ideas take shape.

    Your idea feels both exciting and important (and you've clearly pulled together a strong team). I recently read the idea 'Unlocking health is a community focused health literacy improvement project' and I wondered if there was opportunity for cross learning, both in the way they are identifying the communities key health issues, but also the way you are utilising the third sector to advocate for people who are struggling to access the health systems because of language barriers - I feel this is an important aspect they may wish to consider. I might be off beam here, but I hope not and I hope it helps to make a connection.

    Best of luck as you progress your idea.

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