Inclusion Health Action in General Practice (IHAGP): evaluation

Theme 2: Enhancing workforce knowledge and skills

Theme 2 of the Inclusion Health Action in General Practice (IHAGP) programme focused on enhancing workforce knowledge and skills to enable practices to deliver more inclusive, trauma-informed, and equity-focused care. This theme recognised that reducing health inequalities requires not only structural changes in service delivery but also a workforce equipped with the understanding, confidence, and practical tools to identify and address barriers to care. By investing in staff development, IHAGP aimed to create a foundation for sustainable improvements in patient experience and outcomes.

The rationale for this theme was clear: patients living in socioeconomically deprived areas often face complex challenges, including poverty, trauma, language barriers, and stigma. These factors can make accessing healthcare difficult and can influence how patients engage with services. Staff who understand these challenges and have the skills to respond appropriately are better positioned to provide compassionate, person-centred care. Workforce development was therefore seen as a critical enabler within IHAGP’s Theory of Change, underpinning efforts to improve access and equity.

Objective of the theme

The objective of Theme 2 was to strengthen the capacity of general practice teams to recognise and respond to health inequalities in their day-to-day work. Activities under this theme were designed to:

• Increase awareness of the social determinants of health and their impact on patient behaviour and outcomes.
• Equip staff with trauma-informed approaches to improve interactions with patients who have experienced adversity.
• Enhance communication skills and cultural competence to support patients from diverse backgrounds.
• Improve knowledge of signposting and referral pathways to community and social support services.
• Foster collaborative working within multidisciplinary teams to deliver holistic care.

By achieving these objectives, Theme 2 aimed to create a more inclusive practice environment where staff feel confident in supporting vulnerable patients and where systems are adapted to reduce barriers to care.

Summary of activities

From the implementation data gathered through the monitoring form section of the staff survey, 51% of practices undertook activities in this theme. Practices engaged in a wide range of activities under Theme 2, reflecting the flexibility of IHAGP funding and the diverse needs of local populations. The overarching aim was to build staff capability to deliver inclusive, trauma-informed care and improve patient engagement. Activities included formal training sessions, in-house workshops, online learning, and practical adaptations to support staff in applying new skills.

Types of Training Delivered

Training topics were varied and covered both clinical and non-clinical areas. Common themes included:

• Trauma-informed care: bespoke sessions tailored to practice teams, often delivered in-house.
• Mental health and suicide awareness: including Mental Health First Aid courses.
• Domestic violence and safeguarding: training for clinicians and reception staff on recognising signs and offering covert support.
• Cultural competence and inclusion health: raising awareness of barriers faced by refugees and asylum seekers.
• Communication and signposting skills: enabling staff to direct patients to community resources effectively.
• Specialist clinical topics: such as training on pain management, addictions, frailty, and prescribing requests for gender dysphoria and transgender care patients.

Staff survey data confirm the breadth of training uptake:

• 63% of staff reported training on health inequalities,
• 56% on trauma-informed care,
• 48% on inclusion health and communication skills,
• 21% on mental health
• 21% on cultural competence.

One staff member reflected:

“Mental health first aid was brilliant… It’s maybe too soon for patients to see the impact, but staff feel valued because we’re taking time out to do training and explain systems.”

Participation and Roles

Monitoring data show significant engagement across multidisciplinary teams. Individual practices reported between 2 and 25 staff trained during the March–August 2025 period, with cumulative totals since IHAGP began reaching up to 35 staff and trainees in one practice. Roles included GPs, practice nurses, healthcare support workers, receptionists, practice managers, and community link workers. This breadth of participation ensured that learning was embedded across all points of patient contact.

In addition to training, practices invested in practical tools to support staff in applying their learning. Examples include:

• Interpreting devices such as Vasco Deluxe Translators, enabling reception staff to communicate confidently with patients with additional language needs: “This has made a huge difference to our staff’s confidence when speaking to non-English-speaking patients.”
• Virtual Reality (VR) dementia training kits, used to build empathy and understanding of sensory impairments.
• Updated signage and patient information boards, including translations into multiple languages.
• Clinical equipment such as blood pressure monitors and weighing scales, linked to training on chronic disease management.

Several practices demonstrated creativity in workforce development. One practice developed a “Choose Your Adventure” training game to raise awareness of refugee experiences, while another introduced weekly reflection sessions for healthcare assistants to discuss patient needs and treatment protocols.

Integration with Service Delivery

Training was not an isolated activity; it was integrated into broader changes in practice systems. For example:

• Reception staff extended their roles into clinical tasks such as new patient medicals and blood pressure checks, freeing GP time for complex cases: “As well as my receptionist role, I have now been trained as a Health Care Assistant… This has allowed the doctor more time to deal with the more complicated patients.”
• Practices introduced new policies on safeguarding and communication, developed as a direct result of training.
• Appointment systems were adapted to allow longer consultations for patients with language barriers or complex needs.

Reflections

Implementation

Training under Theme 2 was delivered through a mix of in-house sessions, external courses, and online modules. Practices frequently scheduled dedicated learning time, often facilitated by employing locums to cover clinical duties. This approach allowed staff to attend training without compromising patient care. Some practices closed for short periods to enable whole-team participation, while others integrated learning into routine meetings to maintain momentum.

One practice explained:

“I closed the practice for a few hours to have a practice event. We had a temp on our front desk and a locum in case of emergency.”

Online platforms such as Turas were widely used for modular learning, complemented by bespoke sessions on trauma-informed care and inclusion health. Practices also introduced weekly reflection sessions, enabling staff to discuss patient needs and review treatment protocols:

“We have weekly staff training sessions where we reflect on current practice, discuss difficulties, and review treatment protocols.”

Implementation extended beyond training delivery to system changes. Practices adapted DNA (Did Not Attend) letters to adopt a supportive tone, introduced new safeguarding policies, and updated appointment systems to allow longer consultations for patients with complex needs. These changes were often linked directly to training content:

“Our DNA letters have been completely restructured and are more patient-centred and supportive… These have also been translated to the patient’s own language.”

Benefits

The benefits of workforce development were evident at multiple levels. At the staff level, training improved confidence and morale. Staff survey data show that 76% of respondents reported increased understanding of the challenges patients face, while 41% noted greater job satisfaction and 43% reported improved collaborative working. Staff described feeling more empowered to support vulnerable patients and more confident in handling complex situations:

“Our admin team are more empowered when dealing with difficult patients. They have a little insight into what makes a patient behave in a certain way.”

At the system level, training led to practical improvements in care delivery. Staff respondents reported more robust recall systems for chronic disease management, enhanced signposting to community resources, and better use of interpreting services. One respondent noted:

“We have improved engagement with certain ‘missing’ groups… Training and a better general awareness of inequalities and vulnerabilities has provided many small, day-to-day improvements that may be hard to measure but without a doubt have an impact.”

At the patient level, staff reported improved communication and more holistic care. Some receptionists extended their roles into clinical tasks such as new patient medicals and blood pressure checks, freeing GP time for complex cases.

Perhaps the most significant outcome was a cultural shift toward trauma-informed, equity-focused care. Staff reported greater empathy, patience, and willingness to adapt systems to meet patient needs. As one respondent put it:

“Our general approach when dealing with patients has changed. We take more time to listen and try to explain things to support them when they contact us.”

Challenges

Despite positive outcomes, challenges persisted. 57% of staff responding to the survey cited lack of time as the main barrier to maximising the impact of training. Operational pressures often limited opportunities for reinforcement, and some practices struggled to include all staff in training sessions.

Sustainability was another concern, with practices noting the difficulty of maintaining momentum without ongoing funding and support.

Summary

Theme 2 has delivered strong progress toward its goal of enhancing workforce knowledge and skills to support inclusive, trauma-informed care. Practices implemented a wide range of training activities, including sessions on health inequalities, trauma-informed approaches, mental health, cultural competence, and communication skills. These were complemented by practical investments such as interpreting devices and updated patient information resources, ensuring that learning could be applied in everyday interactions.

Engagement levels were high across multidisciplinary teams, with practices reporting substantial participation in training and development activities. Evidence from monitoring and survey data indicates that these interventions have led to meaningful changes in practice systems and staff behaviours. Practices adapted appointment structures, revised DNA (Did Not Attend) policies to adopt a more supportive tone, and improved signposting to community resources. These changes demonstrate alignment with IHAGP’s Theory of Change, which emphasises workforce capability as a critical enabler for reducing health inequalities.

The benefits of Theme 2 extend beyond individual skill development to systemic improvements. Practices introduced new safeguarding policies, enhanced the use of interpreting services, and strengthened collaborative working within teams. Staff reported increased confidence and understanding of patient challenges, contributing to a more resilient and patient-centred practice culture.

However, challenges remain. Time constraints were the most significant barrier, limiting opportunities for training and reinforcement. Operational pressures and the need to maintain service delivery also affected the inclusion of all staff. Sustainability is a concern, as maintaining momentum will require continued investment to allow time on IHAGP-related themes and ongoing support for professional development.

Overall, Theme 2 activities strongly align with programme objectives and have created the conditions for longer-term improvements in health equity. While the full impact on patient outcomes will take time to emerge, the evidence suggests that this theme has achieved its immediate goals and established a foundation for sustained progress.