Lewisham Council: Health Equity Team (HET) Programme

The Health Equity Teams (HET) programme in Lewisham was developed to address racial health inequalities identified in the Birmingham and Lewisham African and Caribbean Health Inequalities (BLACHIR) report. GP Health Equity Fellows (HEFs) were paired with Black-led community organisations to form health equity teams (HETs) that co-produced local health interventions. The first cycle reached over 2,500 residents and trained 70+ community champions. An independent evaluation led to key improvements for the second cycle, including synchronised recruitment, trauma-informed and anti-racist training, and clearer outcomes tracking. Now embedded within Integrated Neighbourhood Teams and focused on cardiovascular disease prevention, the programme continues to shift how primary care engages with underserved communities to deliver equitable, community-led healthcare.

The HET programme emerged in response to the Birmingham and Lewisham African and Caribbean Health Inequalities Review (BLACHIR), which highlighted stark health disparities facing Black communities. Lewisham Council and South East London ICB launched the HET programme in 2022 to test new approaches to closing this gap by embedding health equity at a hyperlocal Primary Care Network (PCN) level. It was inspired by the North Lewisham PCN (NLPCN) health equity model which ran from 2021 – 2022. NLPCN piloted a community-driven approach to health equity by prioritising an asset-based community development approach led by a resourced Health Equity clinical lead who drove the work forward. 

The core aims of the HET programme were to:

• Reduce health inequalities, particularly among Black African and Black Caribbean communities.
• Build sustained partnerships between primary care and local voluntary sector organisations.
• Improve access to healthcare through culturally relevant, community-led interventions.
• Grow a cohort of health equity leaders with population health expertise.
• Support the development and capacity building of smaller grass roots black led organisations
• Implement relevant BLACHIR opportunities for action.

For the second cycle, the programme has sharpened its focus on reducing cardiovascular disease (CVD) disparities to align with the local neighbourhood plan. This reflects both evaluation learning that outcomes would be easier to track with a specific focus and population health data showing preventable early deaths due to CVD are disproportionately high among Black communities in Lewisham. It also responds to the need to deliver tangible outcomes for all stakeholders including primary care, where the majority of their performance payments are focused on cardiovascular disease. 

The NLPCN model was socialised across the system in various forums including presenting to Lewisham Health and Care Partnership board and the Public Health, Health and Wellbeing Board. The decision to include the scale and spread of the model into the Lewisham Health Inequalities and Health Equity Programme  was taken to support the promising early result of the NLPCN model and the engagement with primary care leading on health equity. Funding initially was identified from the South East London Clinical Commissioning Group (CCG) at the time with additional funding provided by the subsequent South East London Integrated Care Board and Public Health 

Adverts for the HEFs were put out in the primary care leadership forum as well as through the sessional GP WhatsApp group. There were some challenges in recruitment with 4 of the 6 PCNs in place from October 2022 and 2 further HEFs recruited in March 2023.  

The NLPCN health equity lead was recruited into a lead community of practice for Health Equity role and developed an in-house training programme for the HEFs from October 2022- Dec 2022 using Fairer Health online modules and outside speakers covering health inequalities, social determinants of health, BLACHIR, inclusion health and leadership skills. 

The HEFs spent the first year attending public health training at Kings College London from Jan 2023 to Dec 2023. They were able to attend the module delivering public health and primary care and also a bespoke tutorial with the programme director of the Public Health MSc. 

In March 2023 VCSOs were commissioned to work with HEFs and by June 2023 all six teams were formed and working together. The opportunity to work with HEFs was socialised through existing VCSO networks including the Lewisham Black Voluntary Network. A kick-off event set the programme objectives and gave some opportunity for the teams to develop relationships and start to work together. 

The staggered recruitment and lack of support for early coproduction created early misalignment in some of the teams. Also creating learning opportunities for HEFs only worsened existing power dynamics. Based on that learning, the second cycle now:

• Synchronises recruitment of HEFs and VCSOs using a centralised application process, consistent scoring rubrics, and interview panels with VCSO representation.
• Introduces a comprehensive onboarding process with joint HET training developing knowledge together. This includes team induction workshops, co-production training, trauma-informed and anti-racist training, and early relationship-building activities.
• Integrates delivery into Lewisham’s Integrated Neighbourhood Teams (INTs), enabling multi-agency collaboration. 

Cycle 1 achievements: 

• Reaching 2,500+ residents through events and workshops.
• Training over 70 community champions which were more culturally diverse than the existing Public Health champions
• One community champion was recruited to become a PCN social prescriber
• Teams developed a rich understanding of place and community and achieved a clear consensus about how to achieve meaningful coproduction. Most teams effectively collaborated, leveraging community resources to deliver projects that reached Black and underserved populations.
• Project activities included: holistic health fairs providing enhanced screening opportunities including CVD risk assessments as well as blood borne virus screening, culturally tailored peer support mental health interventions and awareness raising, Improved control of diabetes through culturally tailored group consultations for people living with diabetes, complementary therapy service embedded into a PCN and enhanced support for the social determinants of health providing form filling support alongside health checks.
• BLACHIR opportunities for action were progressed creating opportunities for Black-led community groups to co-deliver NHS-supported services, providing smaller black led organisations to develop capacity to bid for larger contracts.

The new cycle builds on this by:

• Focusing on CVD risk reduction to allow clearer tracking of clinical and community outcomes. This has really embedded the program into primary care’s business as usual as there is now an acceptance of a different approach needed to address health inequalities whilst delivering clinical targets and outcomes.
• Providing enhanced support for coproduction for the teams and allowing time to build relationships to hopefully ensure more productive collaborations and truer coproduction addressing the power imbalances we saw in the first cycle.
• Distributing PCN-specific data packs and using a refined outcomes framework to guide intervention design and evaluation delivering outcome reporting to all stakeholders
• Embedding HET teams in INT structures to extend reach into the wider social determinants of health and enable better multi-disciplinary support and integrating the HET programme as a core offer of our neighbourhood model. 

From evaluation, it was learnt that:

• Teams need more time and space to build trust and understand co-production.
• Trauma, racism, and power imbalances must be acknowledged and explicitly addressed.
• Without clear outcomes and infrastructure support, impact can be hard to demonstrate especially for clinical stakeholders.
• Engagement with primary care is contingent on delivery of clinical outcomes. 

In the second cycle the council have:

• Commissioned new training including trauma-informed practice, community organising and enhanced coproduction support.
• Co-developed with teams a memorandum of understanding for partnership working, co-production framework and project planning toolkit to support effective project development.
• Provided structured induction and peer support with all the HET members aligned in one space.
• Standardised quarterly reporting using a shared outcomes framework aligned to public health and PCN priorities.

These changes aim to ensure stronger delivery, clearer impact, and a more supportive experience for participants.

In retrospect, things the council would have done;

• Synchronised VCSO and HEF recruitment from the beginning.
• Provided trauma-informed supervision and joint onboarding earlier.
• Designed outcomes and monitoring tools alongside partners from the start.
• Considered the impact of the commissioning process on partnership working.

All of these lessons have now been incorporated into the second cycle to strengthen delivery and collaboration.

The first cycle was effective in:

• Building trust between primary care and the voluntary sector.
• Developing a new, replicable model of partnership-led care delivery.
• Raising the profile of health equity across Lewisham’s six PCNs.
• Supporting Black led organisation to take a leading role in addressing health equity in Lewisham.
• Reaching underserved residents with innovative community led models of interventions.

The programme has now been recommissioned for a second cycle, embedded into Lewisham’s long-term INT vision. We are establishing more infrastructure around the program such as embedding a community link worker role to support PCNs with their proactive engagement with the community. 

The programme has introduced clearer performance indicators, and established a stronger foundation for long-term impact, evaluation, and scale. As a core component of the INT model we hope that the innovative community embedded programme will demonstrate more tangible clinical outputs to primary care whilst still retaining the magic of working with communities to deliver health interventions. 

The programme is aiming to embed longer term changes to primary care delivery and pushing for increased awareness of health equity for all staff and trying to embed a trauma informed, anti-racist approach prioritising the social determinants of health. Through a legacy of health equity leaders we hope that sustained change can continue in primary care in Lewisham making tangible changes for residents. 

This programme has shown the power of shared leadership between clinicians and communities. Fellows and VCSOs co-designed improvements - enhancing care pathways, championing equity within PCNs, and building trust, access, engagement, and local leadership. The approach values both clinical outcomes (such as blood pressure control and diabetes management) and community outcomes shaped through VCSO partnerships. 

Together, they illustrate how co-production can redefine what effective and inclusive primary care looks like. More information about Lewisham Council’s Health Inequalities work and the full evaluation of the first cycle is available online.