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Background: People with severe and multiple disadvantage (SMD) who experience combinations of homelessness, substance misuse, violence, abuse, and poor mental health have high health needs and poor access to primary care. Aim: To improve access to general practice for people with SMD by facilitating collaborative service improvement meetings between healthcare staff, people with lived experience of SMD, and those who support them; participants were then interviewed about this work. Design and setting: The Bridging Gaps group is a collaboration between healthcare staff, researchers, women with lived experience of SMD, and a charity that supports them in a UK city. A project was co-produced by the Bridging Gaps group to improve access to general practice for people with SMD, which was further developed with three inner-city general practices. Method: Nine service improvement meetings were facilitated at three general practices, and six of these were formally observed. Nine practice staff and four women with lived experience of SMD were interviewed. Three women with lived experience of SMD and one staff member who supports them participated in a focus group. Data were analysed inductively and deductively using thematic analysis. Results: By providing time and funding opportunities to motivated general practice staff and involving participants with lived experience of SMD, service changes were made in an effort to improve access for people with SMD. These included prioritising patients on an inclusion patient list with more flexible access, providing continuity for patients via a care coordinator and micro-team of clinicians, and developing an information-sharing document. The process and outcomes improved connections within and between general practices, support organisations, and people with SMD. Conclusion: The co-designed strategies described in this study could be adapted locally and evaluated in other areas. Investing in this focused way of working may improve accessibility to health care, health equity, and staff wellbeing. [ABSTRACT FROM AUTHOR]

Background: Street sex workers (SSWs) are a highly marginalised and stigmatised group who carry an extremely high burden of unmet health need. They experience multiple and interdependent health and social problems and extreme health inequality. Despite high levels of chronic physical and mental ill-health, there is little evidence of effective healthcare provision for this group. They are often considered 'hard to reach', but many individuals and organisations have extensive experience of working with this group.Methods: We conducted a cross-sectional survey of professionals who work with SSWs in the UK on their perspectives on their access to primary care, mental health, sexual health and drug and alcohol services, how well these services met the needs of SSWs and suggestions of best practice.Results: 50 professionals mostly from England, responded. Mainstream general practice and mental health services were found to be largely inaccessible to SSWs. Sexual health, drug and alcohol services and homeless health services better met their needs; this was mostly attributed to flexible services and collaborations with organisations who work closely with SSWs. The main challenges in providing healthcare to SSWs were services being inflexible, under-resourced services and services not being trauma-informed. Best practice in providing healthcare to SSWs includes- seamless partnership working between agencies with case worker support; peer-involvement in service development and engagement, a range of health provision including outreach, presence in community spaces and fast-track access into mainstream services; trauma-informed, gender-sensitive health services in a welcoming environment with flexible, responsive appointment and drop-in systems and consistent clinicians with specialist knowledge of substance misuse, mental health, domestic violence and homelessness.Conclusions: Access to healthcare for SSWs in the UK is highly variable but largely inadequate with regards to primary care and mental health provision. The examples of positive healthcare provision and partnership working presented here demonstrate the feasibility of accessible healthcare that meets the needs of SSWs. These need to be systematically implemented and evaluated to understand their impact and implications. As we build back from COVID-19 there is an urgent need to make accessible healthcare provision for marginalised groups the norm, not the exception. [ABSTRACT FROM AUTHOR]

Summary: Background: Domestic violence and abuse (DVA) is a leading contributor to the physical and mental ill health of women. Recent international guidance recommends that undergraduate medical curricula should include DVA. We do not know what is currently taught about DVA to medical students in the UK. Recent international guidance recommends that undergraduate medical curricula should include DVA Method: Teaching leads from all UK medical schools (n = 34) were invited to participate in an 18‐item online survey about what DVA education is provided, their views of this provision and any feedback provided by students. Descriptive statistics were used to analyse the data. Results: A total of 25 out of 34 medical schools participated in the survey (74%). All respondents felt that there should be formal teaching on DVA in the medical curriculum. Eighty‐four per cent of respondents reported that there was some formal teaching in their medical school, and 90% of these reported that it was mandatory. Of those who delivered some teaching, 52% reported that the provision was 0–2 hours in total. Most commonly content was delivered in year 4. DVA teaching was delivered in different modules, by different methods and delivered by a range of different providers. Seventy‐five per cent of respondents reported that they felt the provision at their medical school was inadequate or not enough. Barriers to providing DVA education identified included time constraints, failure to perceive it as a medical problem and the assumption that it will be covered elsewhere. Conclusion: Most medical students in the UK receive a small amount of teaching on DVA towards the end of the curriculum. This is perceived as inadequate. [ABSTRACT FROM AUTHOR]

This essay examines contemporary Britain's foodscape in order to identify how mediatised life-quests uphold 'boom-based' culinary/consumptive motifs while mobilising a distinctive 'austerity aesthetic' that coincides and colludes with the British state's neoliberal austerity narrative. In part one, 'The British State of Home-Economics', we examine this austerity aesthetic as it came to the fore during the 'Great British Summer' of 2012. In part two, 'Localism, Veg Patch Capitalism and Austerity', we unpack the fundamental contradictions found in the modesty claims of recent gentrified culinary activities and pastoralised localist discourses. And, finally, in part three, 'Temporal Deficit and Culinary Work-for-Labour', we analyse the foodscape's investment in temporal presumptions, metaphors, promises and paradoxes in order to expose how the structure of deficit that shapes the way capitalism's 'economy of time' is maintained through culinary 'work-for-labour'. Throughout, we use the term 'foodscape' to 'map food geographies' onto cultural activities and socio-economic patterns, and to argue that Britain's contemporary foodscape consistently fuels and reveals the self-contradictory yet self-perpetuating logic of capital as manifest in the neoliberal enterprise of state-led austerity. [ABSTRACT FROM AUTHOR]