Published: 21 April 2023
Those most in need have poorest access to care
Dr Lucy Potter is an academic GP in Bristol who combines her role as a practicing GP with her research into improving access to primary care for people who experience severe and multiple disadvantage, including homelessness, domestic and sexual violence, substance misuse and poor mental health.
Among these are street sex workers who represent some of the most marginalised people in society. They can experience significant barriers in accessing general practice, while negative experiences of healthcare often discourage them from seeking care. “It’s become a real passion of mine – to try and change this situation, because it’s not right that those who most need healthcare have the least access to it,” said Dr Potter.
In 2018, Dr Potter was awarded a 2-year £94,000 NIHR In-Practice Fellowship through the NIHR Academy to support her research role at the University of Bristol, investigating how to make primary care more accessible to those most in need. NIHR In-Practice Fellowships offer funding for qualified GPs, general dental practitioners and community dentists to develop their research skills while continuing their clinical work with patients.
During her fellowship, Dr Potter also ran a drop-in clinic for women who experience sexual exploitation/street sex work at One25 – a charity that reaches out to some of the most marginalised women in Bristol.
“The outreach clinic is so important to support the health needs of these women, but I was always aware of how much more there was to be done. Through the NIHR In-Practice Fellowship I was able to investigate how to improve mainstream general to better meet the healthcare needs of highly marginalised patients.”
Dr Lucy Potter
Reaping the benefits of co-produced research
Dr Potter’s NIHR-funded project involved a national survey of people who worked with street sex workers around the UK, asking them for their insights into sex workers’ access to healthcare services.
The survey asked the questions: “What healthcare is accessible to street sex workers there? What do they do differently? Does it meet their needs?” These insights helped Dr Potter develop best practice guidance for frontline services and commissioners to develop healthcare services for street sex workers (published in BMC Health Services Research).
During this time Dr Potter also began the Bridging Gaps project in Bristol. Working alongside a group of women with lived experience of extensive trauma, Dr Potter and her research team were supported by NIHR ARC West, One25 and local GPs to develop ways of improving access to general practice for marginalised patients.
Their work was funded by a variety of sources, including £30,000 from the NIHR School for Primary Care Research (SPCR) and £62,000 NIHR Research Capability Funding through the NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group.
Marginalised groups are rarely involved in research or service development, but shaping and improving healthcare services was important to the team of women with lived experience. “Together, we developed and delivered online and in-person training sessions with seven general practices, the GP training scheme and developed service improvements with three general practices,” Dr Potter said.
“It’s been amazing to see our lived experience group members realise how powerful they are – seeing their ideas make real changes and understanding that their expertise is valuable and unique.”
Florrie Connell, support worker at charity One25 in Bristol
They also co-authored a book chapter on their management of digital exclusion and co-production through the COVID-19 pandemic and a research article on trauma-informed co-production. The project also won two Great Practice Awards 2020 for ‘Inspiring change’ and facilitating ‘Independent futures’ by the Bristol partnership Golden Key.
Bridging Gaps also developed service improvements such as the new Open Doors clinic at Wellspring GP surgery in East Bristol, designed to help people with multiple disadvantage who may not have accessed general practice for many years. By offering more specialised care, including longer appointments and continuity with clinicians, they are building trusting relationships and delivering better care for those in most need.
Supporting future research leaders to drive change
After securing her present PhD fellowship through the NIHR SPCR PhD Programme for Primary Care Clinicians at the University of Bristol, Dr Potter went on to develop the Connection Study. Supported by Wellcome Trust funding, the SPCR PhD Programme offers training specifically for primary care clinicians, including doctors, nurses and dentists, to help them become research leaders in their field.
“Undertaking the NIHR PhD fellowship is a fundamental step in progressing my career as a clinical academic leader in inclusion health research. I want to challenge health inequalities and improve primary care for patients who need it the most, and champion meaningful involvement of people with lived experience of marginalisation.”
Dr Lucy Potter
“Through the PhD, I’m building on my existing research skills and collaborations while gaining invaluable academic, management and leadership experience,” Dr Potter said. Once complete, Dr Potter will have a rigorously developed intervention to improve access to general practice for the most marginalised populations that will be ready for an evaluation study.
Throughout this research, Dr Potter has contributed widely to discussions around improving inclusion healthcare at national and international events and co-authored a review of health interventions for sex workers in The Lancet Public Health. She has also developed training to support researchers planning to involve marginalised people within their own research and has continued to collaborate with Bridging Gaps through her PhD.