Digital healthcare implications for health inequalities in the UK

In response to COVID-19 there has been a shift in the way in which healthcare services are accessed in the UK with most non-acute healthcare service delivery made remote.  This is against a background of strong and persistent inequities in health outcomes and healthcare access in the UK. Whilst there are hopes that digital healthcare will remove many barriers to accessing healthcare it is also possible that this form of service delivery will both create new types of inequities as well as replicate and re-embed existing ones. This PhD study explores the experiences of changes to GP care amongst marginalised groups in the UK. The study focuses on the different ways in which healthcare work is being created and reallocated in General Practice and the implications of this for care. The research uses the ideas of responsibilisation, work, and candidacy to explore how processes of marginalisation shape experiences of digitalisation of GP services in the UK.

This study took an ethnographic approach over the course of six months (November 2021-April 2022) involving observation and interviews, conducted across a range of field sites in London. These include a foodbank, an advice centre for refugees and asylum seekers, and a charity offering digital support. The research also includes in-depth interviews with GPs from London’s lowest ranking IMD boroughs, members of staff at Digital Health Hubs across the UK, and staff members at the fieldwork site services. The analysis explores the normative expectations being placed on patients and how these work to produce new thresholds for eligibility and types of healthcare work for patients. The way in which this interacts with patients’ capacity is a key question of this research, which focuses on how marginalised groups may be uniquely impacted by changes to GP services. The intention of this study is to feed into practice through a recognition of the potential challenges patients from marginalised groups face in engaging with GP services as well as challenging new assumptions about patients being normalised into practice.