The Bridging Gaps project aims to improve access to GP practices for women who have experienced trauma and have complex needs. Services often aren’t equipped to meet these needs, worsening already severe health inequalities. Bridging Gaps was started by a group of Bristol women who have experienced trauma, including addiction, homelessness, mental health problems, sexual exploitation, domestic and sexual violence, and poverty.
The project was developed together with:
It was funded through the Q Exchange by the Health Foundation and NHS England and NHS Improvement; and National Institute for Health and Care Research (NIHR) Research Capability Funding through the NHS Bristol, North Somerset and South Gloucestershire CCG. It has also been funded by the Co-Production Collective (formerly UCL Centre for Co-production in Health Research) as part of the 2019/20 Phase 2 Pilot Projects and by the NIHR School for Primary Care Research.
Our goal was to improve access to primary care for people who have complex needs and have experienced trauma, in collaboration with GP practices and people with lived experience. We wanted to offer tailored approaches for different GP practices, to improve access for people who may otherwise struggle to get the services they need.
We developed a training course together and facilitated this at five different GP practices. We are working in more depth with three practices to develop practical ways to improve access for people with complex needs. At one of these practices, we have developed a specialised clinic for people with complex needs at Wellspring, an east Bristol practice. This new service is helping people with complex needs who haven’t seen a GP for many years.
Together with the women involved in Bridging Gaps, we have made the case for service changes. We have presented at national and international conferences about what we have achieved and how primary care can be more inclusive for people who might have been homeless or have other complex needs.
We have tried to put the principles of co-production into practice. This includes sharing decision-making and power, and valuing everyone’s knowledge and point of view.
We worked with women with lived experience of complex needs from the start and developed the Bridging Gaps project together. We shared decision-making as much as possible at every stage.
We met every two weeks through the pandemic. Initially, not everyone had the technology to meet online so we made sure that people could get the equipment they needed. At times, though, meetings had to pause to keep everyone safe.
Establishing trust with people who may have been let down by healthcare services was key to the project’s success.
Involving everyone in decision-making was essential. Sometimes there were disagreements on what to do, which we had to discuss and work through together as a group.
GP practices have faced many challenges during the pandemic, including vaccinations and high demand on services. To overcome these barriers, we worked with academic and trainee GPs who had time set aside to be involved in the project. They understood the situation in primary care and what would work.
The chance to make real changes to services was an important reason for women with experience of complex needs to get involved:
“Working with Bridging Gaps has given me a real sense of pride and fulfilment, to actually see changes happening because of such amazing and strong women is fantastic. Working with GPs to be more trauma-informed in services is such a vital part of supporting women who have been through so much in their lives.”
Helping to establish a new clinic at Wellspring GP practice to help people with complex needs access primary care, was a great achievement for those involved in Bridging Gaps:
“Working in collaboration with Wellspring has been such a positive experience. I was surprised at how willing they were to work with Bridging Gaps and how seriously they took our suggestions and feedback.”
Bridging Gaps was awarded two Great Practice Awards 2020 for ‘Inspiring Change’ and facilitating ‘Independent Futures’. These were awarded by Golden Key, a partnership which works to improve services for Bristol citizens with the most complex needs.
We have also been awarded the 2022 University of Bristol Open Research Prize in the category of Widening Reach.
We want to influence regional plans for health and social care that meets the needs of those who have experienced trauma. We are working with decision-makers from the Bristol, North Somerset and South Gloucestershire Integrated Care System. Working with these policy and decision-makers will help our work to be part of the plans for the region.
Using the work from Bridging Gaps at a regional level will avoid duplication of effort. We hope our interventions can be used across the whole region. Most importantly, the voices of those with lived experience will be heard when decisions are being made.
We are keen to work with the new Changing Futures programme that is being developed in Bristol. This programme aims to provide more tailored support for adults facing disadvantages such as homelessness, mental health problems, substance use, domestic abuse or who are in the criminal justice system. NIHR ARC West will be evaluating this programme.
We are completing our service improvement work with GP practices and will share our findings with others when they are published. We also plan to develop more ways to improve primary care for people with severe and multiple disadvantages.
NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (BNSSG CCG) is the organisation responsible for commissioning hospital and community health services to ensure that the health needs of BNSSG's population are met. It is made up of local GPs and health professionals from the 85 local practices, working together with other clinicians and patients to decide how the local NHS budget should be spent.