Deliver the Primary Care Network (PCN) service specification on Tackling Neighbourhood Health inequalities (TNHI)

Tackling Neighbourhood Health inequalities (TNHI)


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The TNHI specification requires PCNs to identify a population within the PCN experiencing inequality in health provision and/or outcomes, and have developed a plan to tackle the unmet needs of that population.  We would encourage practices to think about cancer prevention particularly smoking cessation, and/ or cancer screening.

What’s required in 2022/23 for Tackling Neighbourhood Health Inequalities in relation to Cancer

  • Identify a lead for tackling Health Inequalities within the Primary Care Network
  • Use data and local engagement to identify a population experiencing inequality in health provision and/or outcomes that the PCN would like to improve
  • Identify measures, interventions and plan the improvement
  • Deliver the intervention and measure

Getting started – Tackling inequalities through smoking cessation

Smoking is one of the leading drivers of health inequalities, responsible for half the difference in life expectancy between the lowest and highest income groups in England, as well as being the biggest cause of cancer in the UK. Furthermore, people with co-morbidities can face challenges in securing a cancer diagnosis and in receiving optimal treatment, both of which can compromise their cancer outcomes. Smoking also increases the risk of developing many other health conditions including Coronary Heart Disease, heart attack, stroke and so there is a wider health benefit than just cancer, which may be an additional strength of this suggestion at a system level.

Read Cancer Research UK’s ‘Making Conversations Count for All’ which highlights the benefits of improving delivery of smoking cessation interventions for different socio-economic groups and particularly highlighting the role of Primary Care.

  • Find out the criteria and refer people to local Stop Smoking Services, or consider in practice support
  • Look at smoking data through OHID fingertips and identify population groups of greatest need
  • Understand how smoking status is currently recorded in the PCN
  • Training and information on Very Brief Advice (VBA) for whole practice teams
  1. Visit the NCSCT for open access training on VBA, or the RCGPs online training for members
  2. Visit the Cancer Research UK webpages on smoking cessation for more practical support
  1. PCNs can use the Additional Roles Reimbursement Scheme (ARRS) to fund additional specific roles to create bespoke multi-disciplinary teams, to make support available to people where it is needed the most.
  2. Explore how the wider practice team (including ARRS) roles can use VBA in interactions with patients
  3. Read CRUK’s blog post on ‘Health inequalities: Why do people smoke if they know it’s bad for them?’ which highlights groups at higher risks and why some people are more likely to smoke
  4. Provide patients with CRUK’s information leaflets on stopping smoking and other prevention areas, available to order for free. These leaflets are designed to help overcome information barriers that prop up some smoking inequalities.
  5. Signpost patients to our website for further information, which is written in plain English

Getting started - Tackling inequalities in cancer screening

Certain groups of people are less likely to attend screening. We know that cancer screening saves thousands of lives each year, so it’s important that as many people have the access, support, and tools they need to make an informed decision about attending cancer screening.

  • Read Cancer Research UK’s ‘Reducing inequalities in cancer screening’ document and follow the suggested practical tips to help address inequalities in bowel, breast and cervical screening, as well as signposting to further resources and information
  • Utilise Enhanced Access arrangements to provide bookable appointments for patients wishing to have screening, which can be delivered by members of the multi-disciplinary team. Ensure enhanced access hours are in line with patient need locally and agreed with commissioner.
  • Refer back to our ‘Getting started’ section on the PCN DES for early diagnosis and improving the local uptake of National Cancer Screening Programmes.


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