Strengthening partnerships to improve primary care in the Deep End

Posted by Dr Angela Wearn, Associate Member of Fuse and Advocacy and Engagement Lead for the Deep End Network North East and North Cumbria

In this blog, Angela reflects on what people living in some of the region’s most disadvantaged communities have told the Deep End Network about challenges they face when it comes to accessing primary care, including attending appointments, and what we can do to improve this.

The Deep End Network is a growing GP-led international movement that began in Glasgow in 2009 as a response to the ‘inverse care law’, which is that those who need care the most often struggle the most to access it.

The North East and North Cumbria Deep End Network was established in 2020, with support from Fuse, the Centre for Translational Research in Public Health, and the NIHR Applied Research Collaboration North East and North Cumbria, creating a space for practitioners working in areas of severe socioeconomic disadvantage to share experience, shape solutions, and influence how primary care can better meet the needs of the people it serves.

Funded by the North East and North Cumbria Integrated Care Board, the Deep End Network focuses on four core priorities:

• Workforce: Building and retaining a well‑supported workforce in high‑need communities.
• Education: Strengthening training at all levels so current and future health professionals understand health inequalities and access to opportunities
• Advocacy: Ensuring Deep End practices and communities shape local and regional decisions on funding, access and service design.
• Research: Evaluating Deep End initiatives to understand what works, why it works, and how effective approaches can be scaled to improve outcomes.

Since 2023, I’ve been working as Advocacy and Engagement Lead to build and strengthen partnerships between Deep End communities, practitioners and researchers, ensuring the experiences and perspectives of underserved patients and communities inform both our research portfolio and the wider support and initiatives we offer practices.

Over this time, additional funding and support from across NIHR infrastructure, including the NIHR Applied Research Collaboration North East and North Cumbria, NIHR Three Schools and NIHR Research Delivery Network, has further supported targeted involvement and engagement work with those living in Deep End neighbourhoods, the majority of whom have had no previous experience of involvement in research or service development.

Support through the NIHR Three Schools collaboration was made possible through membership of Fuse, which is part of the NIHR School for Public Health Research, one of the three NIHR schools within the collaboration.

What we’re hearing from Deep End communities

Many Deep End patients face multiple, overlapping challenges including low income, insecure housing, poor mental or physical health, caring responsibilities, trauma, or homelessness. These pressures make it harder to engage with primary care, even when people want to.

Through conversations, workshops, and community-led sessions, people have shared why engagement can feel difficult:

• Personal pressures: the emotional and practical effort of attending can feel overwhelming and ‘too much’ on the day of the appointment.
• Feeling unheard or stigmatised: which makes reaching out feel pointless.
• Time and capacity: life can be busy, chaotic, and demanding, with health often taking a backseat.
• Overwhelming contact routes: getting through to the practice or accessing a suitable appointment can feel impossible.
• Negative past experiences: GP practices don’t always feel welcoming or safe.

Overall, I regularly hear that disengagement is rarely about disinterest, it’s about the collective barriers that build up and make staying connected to care difficult.

What communities say needs to change

Improving patient engagement in Deep End areas is complex. There is no single fix, and practices are working under significant resource constraints. But through our involvement work, communities have highlighted three priorities for investment and change that they feel would make a meaningful difference:

• Improve connection and communication
• Strengthen co‑design approaches
• Build sustainable, community‑based partnerships

These priorities align strongly with national ambitions around personalised care, prevention, and reducing inequalities, and they reflect what people say would help them feel more able to engage with primary care as the wider system shifts towards more integrated neighbourhood-level working.

Moving forward together

The NHS encourages practices to work closely with Patient Participation Groups (PPGs), but Deep End practices face additional challenges: limited resources, diverse patient needs, and complex barriers to involvement. From the community perspective, awareness of PPGs is low, confidence is often limited, and many people are unsure whether their voice will genuinely matter. To support better partnership working, the Deep End Public Advisory Group identified three simple involvement principles that are easy to remember and act upon, and clear enough to come back to when things get busy or complex:

• Make it easy
• Make it worthwhile
• Value patient experience

These principles are practical, community-informed and can be applied across a range of contexts to guide diverse involvement.

New one‑page resources for practices

To help bring these messages to life, we’ve co‑developed two infographics with Deep End patients, communities, and Nifty Fox. They distil community insights into quick, usable one-page resources that GP practices and other decision-makers can draw on to strengthen engagement and build more inclusive partnerships.

Supporting Patient Engagement in the Deep End: insights from the community
Working Better Together in the Deep End: patients and GP practices as partners

These resources will sit alongside a wider collection of materials, including a public‑facing animation and an illustrated impact report, which will be shared over the coming months. A celebration event is planned for early next year.

Why this matters

The Deep End Network exists because tackling health inequalities requires more than goodwill, it requires meaningful partnerships and system‑level commitment. These new resources are an important step in supporting practices and others to work alongside communities in ways that feel respectful, realistic, and rooted in the experiences of people who face the greatest barriers to accessing and influencing the care they receive.

We hope they support teams across the North East and North Cumbria and beyond to strengthen relationships, reduce barriers, and create primary care environments that are more responsive to the needs of communities most affected by health inequalities.

If you would like to know more about partnership working, co-production or our involvement work in the Deep End please contact Dr Angela Wearn (angela.wearn@newcastle.ac.uk)

Find out more about the Deep End Network

About the author

Dr Angela Wearn is Advocacy and Engagement Lead for the Deep End Network North East and North Cumbria and a Research Fellow with the NIHR Applied Research Collaboration North East and North Cumbria. She is also an Associate Member of Fuse, the Centre for Translational Research in Public Health.

Spark ideas, inspire change and fuel innovation - sharing research creatively

Posted by Ella Anderson, Fuse Public Involvement and Engagement Manager, Newcastle University

Have you ever wondered how to share your research in a way that engages with new and diverse audiences? Are there ways to share your work in a way that reaches the people it was designed to serve? If the answer is yes, then read on!

Research can spark ideas, inspire change and fuel innovation but all too often it gets buried in academic journals and dense reports that few people read, particularly the communities the research intends to serve. So what if there were more engaging, creative and accessible ways to share your findings? From interactive infographics and animations, to events, theatre and podcasts, Fuse researchers are re-imagining how to communicate their work with wider audiences.

Whether you are looking to captivate the public, influence policy makers or engage fellow experts, this post explores some creative ideas to make your research truly resonate.

• In the first instance, reach out to any people who you have worked with as part of your research including public partners, young people, charities and voluntary organisations. What would they like to see? Actively liaise with and listen to the communities your research is intending to serve - how do they want findings presented?

• Infographics and visual summaries can be a useful way to transform your findings into a simplified visual. Infographics are a graphic representation of information, data or knowledge to present complex content quickly and clearly. Emma Adams has worked with More than Minutes to summarise research about co-located services in a visual and accessible way. Steph Scott worked with Nifty Fox - specialists in visual storytelling - to produce a flipbook drawing on content from the ‘Divided Households’ report relating to children and parental imprisonment. Fuse Deputy Director Amelia Lake, Shelia Visram and team co-produced the Hyper Energy drink leaflet with young people to communicate key findings. Or what about a zine (DIY-style booklet or magazine) like this, ‘Moving Spaces’, co-produced by Caroline Dodd-Reynolds with LGBTQIA+ young people, exploring how physical activity spaces could be more joyful and safe.

• Short engaging videos, animations or explainers can be a great way to summarise research and impact. Using personal case studies or testimonials can make content more relatable to different audiences. For example, AskFuse (our research & evaluation service) collaborated with Newcastle Gateshead Clinical Commissioning Group to produce this video: How a 'Little Orange Book' is giving expert advice to help poorly kids.

• Theatre and performance is an exciting way of communicating research. For example, Cap-A-Pie and researchers including Mandy Cheetham were involved in developing an emotive theatre production called Credit, based on stories and experiences of people living on Universal Credit.

 

• Creative and engaging community events and workshops (with catering if you have budget!) are always a popular option. The more interactive, accessible and collaborative the better. Use the opportunity to close any feedback loops with people, charities, organisations who you have engaged with throughout the research. Show how you listened, what you found out, how findings are applicable to people's lives and work, and what happens next... keeping people in the loop is so important. Be sure to include opportunities for plain language Q&As and conversations, both informal (through breaks) and formal (via panel discussions). At one of Fuse’s International Women’s Day events, there was an optional gong bath for people attending the event. Although a sound bath may not have been directly linked to the research, the event was about creating a welcoming, inclusive and ‘safe space’ for people to come together.

• If you have the budget, consider having an event doodled in real-time. We have had colleagues who have worked with Camille Aubry, Josie Brookes and Nifty Fox who offer this skill. Get in touch with us if you would like any other recommendations when sourcing quotes.

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  Have you thought about gamification of research findings or using interactive digital tools? You can create interactive quizzes or clickable maps to allow people to explore findings in an engaging way, applying insights to local contexts. Simulation tools allow public partners and individuals to visualise the impact of different public health interventions based on research findings. Take a look at Joanne McGrath's online Maze, which provided an interactive resource portraying women’s narratives of multiple exclusion, homelessness and accessing support.

• Storytelling has long been a way to share information. Case studies lend themselves well to this, as human-centric narratives show the research in action. It can demonstrate how a specific person or community has benefitted or will benefit from the findings. Stories are a different way to 'humanise' data or translate findings in a way that is appropriate for the intended audience. For example, Cassey Muir and Ruth McGovern’s co-produced Twinkle Twinkle Arti children’s story book communicated messages about parental substance use in a gentle, age-appropriate manner. The book is available as a physical copy, an electronic copy and also has been made into a CBeebies style story time video.

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  Are there any opportunities for the use of creative methods throughout the project that you could bring together as part of an exhibition in a public space e.g. library, community centre, schools? Documenting the research and experience through photography, crafts or art can be a creative way of capturing interest and making research more understandable. Sarah Martin-Denham’s crochet blanket made up of 2,999 squares representing the number of children excluded every day from schools in England (2021/22 academic year) is a great example of this, and has been on a national tour engaging with 24 organisations - including the Children’s Commissioner Office and multiple councils.
  

• You can share bite-sized research or findings through social media channels using visuals, animations, short videos - or even livestreaming to provide information and engage with people in real-time. Have a hashtag at the ready to encourage people to join the conversation and share perspectives. In a similar vein, there are opportunities to share research and knowledge via 'Ask Me Anything' style forums, for example as seen on Reddit. Yes, this is low cost but it comes with risks as questions are unpredictable! However, it is worth flagging as an option and is a creative, ‘non-traditional’ way to share research and answer questions.

• Blogs, like the award-winning one you are reading right now, are a great way to share your research. Posts can make complex information more accessible to a wider audience. It allows you to present findings in a clear, engaging and informal style, reaching readers outside of academic circles, including policy makers, practitioners and the wider public. For guidance and support in writing your own blog post, contact Fuse Communications Manager, Mark Welford: m.welford@tees.ac.uk.

• Could you take your research findings to places in the local community? Fuse colleagues Balbir Singh (Artistic Director of the Balbir Singh Dance Company) and Paul Chazot displayed art works from their Unmasking Pain project in pop-up displays in GP surgeries and a repurposed shop in a shopping centre. There is now a dedicated space at the Grainger Market, Newcastle-upon-Tyne called the Being Well Place, which is a place to connect and engage with the local community.

• Do you have the option of translating materials/outputs for different audiences, and communities with diverse language needs? Translated summaries and visuals e.g. in multiple languages, work well and ensure inclusivity in dissemination. For example, Nicola Heslehurst worked with local designer, Twentyseven Design to develop English and Welsh infographics relating to pregnancy outcomes.

• And finally what kind of Fuse Public Involvement and Engagement Manager would I be if I wasn’t promoting the wonderful and award-winning public partner-led podcast Public Health Research and Me?! Accessible, informative, flexible and friendly - this is a great way to share quality research with a diverse and international audience. 

There are many more creative ways to share research and remember - there is a no ‘one-size-fits-all’ approach to sharing your findings. Always take into account your research topic, your findings and above all your target audience.

Why not send us a message today if you have used a creative or innovative way to share your research or findings? We would love to hear from you and find out more ways to promote and share high quality research.

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Following strong interest from Fuse members, we have launched a Community of Practice (CoP) focused on creative research, involvement and dissemination.

The first meeting will take place in the New Year. Places are limited for the first event but please register or get in touch (info@fuse.ac.uk), as there will be plenty more opportunities in future!

A CoP is a network of people who share common interests and goals, creating a space for knowledge exchange, learning, and mutual support.