Meet the team
Senior Research Associate (Qualitative Research)
NIHR Applied Research Collaboration West (NIHR ARC West)
- England - West
GP for the Homeless Health Service
Bristol Homeless Health Service/ One25
- England - West
- Six women who've experienced trauma
- Sarah Moore & Kathryn McGregor, GP trainees
- Helen McGeown, GP
- Maria Carvalho & Kate Lemon - One 25 charity
- Chris Mills - Bristol, North Somerset & Gloucestershire Clinical Commissioning Group
- Natalia Lewis - researcher trauma-informed care
- Jeremy Horwood, Associate Professor (supervisor to Lucy and Michelle)
- Gene Feder, Professor (supervisor to Lucy)
What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?
Women with complex needs (e.g. addiction, mental ill-health) often have experienced extensive trauma such as sexual violence and exploitation, domestic abuse, homelessness and children-taken-into-care. Services are often ill-equipped to meet these extensive needs, worsening already severe health inequalities.
Bridging Gaps is a collaboration between women with lived experience, GPs, University of Bristol researchers, the local CCG and One25, a charity serving some of Bristol’s most marginalised women. Women have shared stories of stigma, discrimination and re-traumatisation when accessing healthcare services; these are key reasons for disengaging.
1. Bridging Gaps women received trauma-informed care training and enriched this with lived experience to co-design training and quality improvement projects (QIPs) for Bristol GP practices.
2. Bridging Gaps supported a local surgery to develop a specialised clinic; the surgery is now seeing patients with complex needs who have not consulted for years.
We now want to develop this work further.
What does your project aim to achieve?
Our overall aim is to improve access to primary care for people with complex needs, ensuring that services are more trauma-informed. COVID-19 is sharpening health inequalities. Primary care has rapidly increased remote consultations, but some clinicians are concerned about their implications on health inequalities. We want to improve access for people with complex needs and will use this project to understand:
1. What components are needed in a collaborative service improvement intervention between women with complex needs, an organisation that supports them and general practice?
2. What outcomes matter to people with complex needs, general practice and commissioners when trying to improve access to trauma-informed primary care?
How will the project be delivered?
This collaboration is steeped in co-production principles, with Bridging Gaps women making key decisions at every juncture. We have blended the knowledge of lived experience from the women, service delivery from GPs and latest research from academics to create trauma-informed training materials. We plan to:
1. Deliver trauma informed care training sessions with GP practices. These will be delivered by our team of clinicians and women with lived experience, supported by researchers.
2. Collaborate further with up to 3 of the surgeries who we have relationships with to co-design other aspects of the service improvement package. These co-design meetings will take the form of collaborative meetings between the Bridging Gaps team and 2 clinicians (or one clinician and one manager) from the GP surgery. The surgeries we collaborate with may be able to pilot some of these changes. We will be meeting regularly as a team to develop our ideas and plans.
How is your project going to share learning?
This award-winning Bristol-based collaboration has been running for 18 months. Learning includes how to successfully engage marginalised groups (and busy GP practices!); combine the knowledge of marginalised groups, GP practices, charities and researchers; and co-produce trauma-informed training and quality improvements. Through our work together Bridging Gaps has learnt many lessons about how to co-produce work together in a more trauma-informed way, working to support service improvements whilst at the same time supporting people’s own personal development.
Several Q community SIGs may be particularly interested in Bridging Gaps including primary care, co-production, measures for improvement, women’s health, mental health and developing improvers. Through these networks, we will share learning. With the Q community we want to further refine the intervention so we can understand which components of it help to enable changes and improve access to primary care, and help expand our work.
How you can contribute
- Sharing strategies and best practice to improve access to primary care for people who face health inequalities and have experienced trauma.
- How to engage with primary care services and create service improvement work when they have multiple demands placed on them - even more so now with the COVID-19 pandemic and vaccination work.
- Any experience/ guidance on what and how to measure improving access to trauma-informed primary care for people with complex needs.
- Thinking through how to potentially scale up the project
- Website design and social media support
|1 Jun 2021||Start delivering GP practice training sessions|
|1 Sep 2021||Collaborate with GP practices to develop service improvements|
|1 Oct 2021||Start developing website & wider communications strategy|
|30 Apr 2022||Finish all training delivery to primary care practices|
|31 May 2022||Finish co-creating communications and scaling up strategy|
|30 Jun 2022||Q Exchange project concludes|
1 Oct 2021
What have you learned so far, either from the successes you have had or from where things haven’t gone to plan?
We have received additional funding through our Clinical Commissioning Group to be able conduct some evaluation and research on our approach and are currently writing up our learning about how co-production methods need to be more trauma-informed, to be able to support the involvement of people who’ve experienced complex trauma in service improvements and health research.
During the 2021 winter lockdown months we had to pause our co-production meetings as community centres were shut and not everyone had a safe space to access online meetings. We re-started meetings in April when community centres re-opened but the impacts of lockdown had been harsh on people, and so we had a smaller group of women to begin with. We have developed a new recruitment process for new members with lived experience to get involved.
Because of the lockdown and the fact that GPs were busy vaccinating everyone, we had to cancel the training that had been planned up to April 2021. Since April we’ve been consistently meeting every fortnight and have reviewed the training and our offer to GPs. We have developed a plan for a series of meetings with GP practices to support them in reviewing and improving their access to trauma-informed care for people with complex needs. From our previous work, we have learnt that one-off training events don’t always enable an interactive process, and that we need to work with GPs in the longer term to be able to implement changes on the ground. We have also reflected that previous training materials put an emphasis on women with lived experience sharing their own encounters with primary care. This had the potential to retrigger trauma when discussing difficult experiences with strangers in a professional setting. Going forward, future discussions will have more of a collaborative style, focusing on working alongside practices to come up with practical solutions to barriers to providing trauma-informed care.
What could others learn from your experience of working with a range of stakeholders and collaborating across boundaries (geographical, professional, sector) – including what is working well and any challenges you have faced?
As a team we comprise researchers with expertise in coproduction, GPs, women with lived experience of trauma and women working with those with trauma backgrounds in the third sector. Combining our experiences enables us to provide practical advice that is directly applicable to primary care. We have successfully collaborated with representatives from the local Clinical Commissioning Group to enable us to provide funding streams for practices engaging with our work. At the regional level, we are working with various stakeholders across the Integrated Care System to influence plans for delivery of trauma-informed health and social care across Bristol, North Somerset and South Gloucestershire. Ensuring collaboration with those in charge of policy decision-making will enable our work to be incorporated within broader plans for the region. This will avoid duplication of effort and hopefully enable our interventions to be developed in such a way as they can be delivered at scale in the region. Most importantly this ensures that the voices of those with lived experience will be represented ‘at the table’ where decisions are being made.
There have been many challenges for GP practices during the pandemic, including the roll-out of vaccinations and demand on services so it has been really helpful to work with academic GPs and trainee GPs who both have particular time set aside to be able to get involved in this project and have an understanding of the current climate in Primary Care and what might be feasible. We have learnt the importance of a flexible approach and have used technology to support this. Whilst some women have found online meetings helpful, for others they have been impossible to attend safely. Online meetings also present challenges in terms of fostering positive relationships, forming bonds and understanding how people are feeling. As a result of our learnings we have moved back to face to face meetings but with the option of joining online for anyone who feels more comfortable to do so (and can do so safely in a confidential setting).
What are the next steps for your project over the coming months?
In addition to our work at the regional level within the local Integrated Care System, we are working closely with some practices individually. Our goal is to collaboratively develop trauma-informed service improvements/ interventions for people who have complex needs, offering a specific tailored approach needed for different GP practices and their populations. We will use learning from our collaborations with one practice in which a new ‘Open Doors’ clinic set-up has been trialled. Key questions which we will address include:
- How to identify people on the register who may have complex needs and who are not accessing primary care
- Understanding clinical encounters- are they trauma-informed? How to optimise this
- What training/expertise do clinicians /reception need?
- How to improve the interface between clinician and social prescriber/ support worker
- Pathways and communication into and out of primary care e.g. referral pathways, links between agencies, drop-in availability/ fast track appointments
How can the community get involved in your project?
We hope to link in with the Q community co-production special interest group to share our learning on how co-production can be more trauma-informed. We would also like to share our learning with the primary care special interest group after we have done some more in-depth work with individual GP practices. If others involved in primary care, women’s health, and mental health are interested in developing work on trauma-informed care then please get in contact and we can share learning.