• Led by The Clinical Effectiveness Group, Centre for Health Science, Queen Mary University of London, working with Tower Hamlets PCT, Social Action for Health, and City University London.
  • Ran from 2007 to 2010.
  • Focused on three disease areas which contribute most to poor health in Tower Hamlets – diabetes, cardiovascular disease and chronic obstructive pulmonary disease (COPD).
  • Addressed the needs of both patients and GP practices to improve access to appropriate services.

Three diseases contribute most to poor health and low life expectancy in Tower Hamlets in east London: diabetes, cardiovascular disease and chronic obstructive pulmonary disease (COPD).

This project sought to help GPs to identify risk factors for the conditions among different population groups, reduce health inequalities and improve people’s access to services. They carried out the following activities:

Conducting health equity audits: The use of health equity audits at PCT and at practice level demonstrated differences in key disease indicators which could then be addressed by primary care teams. The project team examined GP practice data to investigate whether there were differences in prescribing and other markers of care quality for people by age, sex and ethnicity. Reports show how all practices performed for the different disease areas.

  • Supporting self-management: They developed a package of measures to help patients work in partnership with their GPs to manage their own condition more effectively. By making patients feel more in control and changing services to make access easier, the aim was to increase access to services and reduce pessimism and apathy among patients.
  • Improving referral: Addressing the differences they found in practices’ referral processes by working with each practice to devise the best way to ensure that self-management and use of specialist nurses were well understood and that appropriate patients were referred to these services. This included the recruitment of 'practice champions.'


The work has helped people access the right services and receive appropriate treatment for their condition. Results showed a year on year improvement over the lifetime of the project in the majority of chronic disease indicators across east London general practice.

The use of health equity audits also helped to demonstrate differences in service provision that were otherwise hidden and hard to identify. 

Further reading

Research report

Involving primary care clinicians in quality improvement

April 2012
Research report

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