Reducing health inequalities through general practice: protocol for a realist review (EQUALISE).

INTRODUCTION: Healthcare organisations recognise the moral imperative to address inequalities in health outcomes but often lack an understanding of which types of interventions are likely to reduce them. This realist review will examine the existing evidence on the types of interventions or aspects of routine care in general practice that are likely to decrease or increase health inequalities (ie, inequality-generating interventions) across cardiovascular disease, cancer, diabetes and chronic obstructive pulmonary disease. METHODS AND ANALYSIS: Our realist review will follow Pawson's five iterative stages. We will start by developing an initial programme theory based on existing theories and discussions with stakeholders. To navigate the large volume of literature, we will access the primary studies through the identification of published systematic reviews of interventions delivered in general practice across the four key conditions. We will examine the primary studies included within each systematic review to identify those reporting on inequalities across PROGRESS-Plus categories. We will collect data on a range of clinical outcomes including prevention, diagnosis, follow-up and treatment. The data will be synthesised using a realist logic of analysis. The findings will be a description and explanation of the general practice interventions which are likely to increase or decrease inequalities across the major conditions. ETHICS AND DISSEMINATION: Ethics approval is not required because this study does not include any primary research. The findings will be integrated into a series of guiding principles and a toolkit for healthcare organisations to reduce health inequalities. Findings will be disseminated through peer-reviewed publications, conference presentations and user-friendly summaries. PROSPERO REGISTRATION NUMBER: CRD42020217871.

Developing an environmentally sustainable NHS: outcomes of implementing an educational intervention on sustainable health care with UK public health registrars.

UNLABELLED: Environmental sustainability is a new and fast moving field in health. There is little evidence about how to teach it effectively to health professionals. METHODS: We conducted a pilot study of an educational intervention with more than 200 UK public health registrars. The intervention consisted of a day-long workshop with the aim of training participants to help make the UK's National Health Service more environmentally sustainable. RESULTS: We measured outcomes in three areas: awareness, advocacy and actions. Comparison of baseline and post intervention questionnaire scores showed statistically significant improvements in the awareness and advocacy scores. Actions were assessed qualitatively. Our findings suggest that, while there are some pockets of good practice, many health professionals are yet to engage with sustainability in the workplace. DISCUSSION: We propose reasons why health professionals are yet to become involved in sustainability issues despite the related opportunities for health and health services.