• Lucy Potter, Tracey Stone, Florrie Connell, Jeremy Horwood, Helen McGeown, Helen Cramer, Gene Feder, and Michelle Farr.
• University of Bristol.
• Br J Gen Pract. 2023 Jul 1; 73 (suppl 1).

BackgroundPeople who experience severe and multiple disadvantage (SMD - including combinations of homelessness, substance misuse, violence and abuse, and poor mental health) have high health need and poor access to primary care. Access to care requires the 'human fit' between the patient and healthcare staff.AimThis study aimed to co-produce service improvements in primary care to improve access for and with people with SMD and explore the perceptions of professionals and people with lived experience who contributed to these service improvements.MethodBridging Gaps is a collaboration between healthcare staff, women with lived experience, and a charity that supports them. We used a co-production approach, where people with lived experience are involved in decision-making throughout the process. A thematic analysis was performed of 12 observed collaborative service-improvement meetings, feedback from 3 GP trainees involved and interviews with 14 professional and lived experience collaborators on the project.ResultsCo-produced outcomes included a clinic designed for and with people with SMD; two Inclusion Health Care Coordinators, and a document for people with SMD to share information with their practice. Key themes from the data included protecting resource to enable cultural shift to proactive relationship-based care; and the benefits to marginalised patients, services, and professionals of having collaborative space to develop positive changes.ConclusionCo-produced service-improvements to improve access to primary care for marginalised patients were valued, possible, and of benefit to patients, staff, and services. This study offers valuable insight into how we can better include and care for marginalised patients in primary care.© British Journal of General Practice 2023.

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