Plymouth Deep End Research

Research, Innovation and Advocacy in Communities Experiencing Health Inequality

Plymouth Deep End supports research, evaluation and innovation focused on reducing health inequalities in communities experiencing the greatest social and economic disadvantage.

Our work is grounded in frontline general practice and shaped by the experiences of patients, communities and clinicians working at the “Deep End” of healthcare.

We believe research should not sit separately from patient care. Instead, it should emerge directly from the realities of frontline practice and help create better, fairer and more compassionate systems of care.

Our research and development work focuses particularly on:

• Health inequalities and deprivation
• Trauma-informed care
• Inclusion health and homelessness
• Complex multimorbidity
• Mental health and addiction
• Community-centred healthcare
• Workforce development and education
• Prevention and early intervention
• Equity in healthcare systems

Why Research Matters

People living in the most deprived communities experience significantly worse health outcomes and often develop illness earlier in life.

Patients in Deep End communities are more likely to experience:

• Premature multimorbidity
• Mental health difficulties
• Adverse childhood experiences and trauma
• Substance misuse and addiction
• Housing insecurity and homelessness
• Barriers to accessing healthcare
• Social isolation and poverty

At the same time, practices serving these populations frequently face higher workloads, greater complexity and reduced resources.

Research at Plymouth Deep End aims to better understand these challenges and develop practical, evidence-based approaches that improve care, strengthen communities and reduce inequality.

Our Research Priorities

Health Inequalities

We investigate how deprivation, poverty, housing instability and social exclusion shape health outcomes and access to healthcare.

Our work explores:

• The social determinants of health
• Inequalities in access to primary care
• The impact of deprivation on long-term illness
• Healthcare inequity and the Inverse Care Law
• Population health approaches in deprived communities

Trauma-Informed Care

Many patients attending Deep End practices have experienced significant trauma, adverse childhood experiences or chronic stress.

We are developing and evaluating trauma-informed approaches that recognise the long-term impact of trauma on physical and mental health.

Areas of interest include:

• Trauma-informed primary care
• Chronic pain and trauma
• Frequent healthcare attendance
• Mental health and emotional regulation
• Polypharmacy and dependency
• Relational and continuity-based care

Homeless and Inclusion Health

Plymouth Deep End has a longstanding commitment to inclusion health and healthcare for people experiencing homelessness and social exclusion.

Our work includes outreach-based healthcare, addiction services and integrated community partnerships.

Research themes include:

• Access to care for homeless populations
• Barriers to engagement with healthcare
• Hospital discharge and continuity of care
• Self-discharge and incomplete care pathways
• Substance misuse and complex health needs
• Integrated outreach models

Complex Multimorbidity

Deep End practices frequently care for patients living with overlapping physical illness, mental health difficulties and social complexity.

We are interested in improving care for patients with:

• Premature multimorbidity
• Chronic disease in younger populations
• Mental and physical health comorbidity
• Long-term pain and medically unexplained symptoms
• Addiction and dependency
• High healthcare utilisation

Community Health & Wellbeing

We believe healthcare works best when it is connected to communities.

Plymouth Deep End supports community-based approaches that strengthen wellbeing, prevention and social connection.

Areas of interest include:

• Social prescribing
• Community health hubs
• Partnership working
• Prevention and early intervention
• Community engagement
• Neighbourhood-based healthcare models

Education & Workforce Development

Education is central to the Deep End approach.

We work with medical students, GP trainees and multidisciplinary learners to improve understanding of health inequalities, trauma and complex care.

Research interests include:

• Deep End placements and training
• Health inequalities education
• Workforce recruitment and retention
• Developing future Deep End clinicians
• Interprofessional learning
• Leadership development in underserved communities

Current and Emerging Projects

Trauma-Informed Clinics

Plymouth Deep End has developed trauma-informed clinic models for patients with high levels of complexity and healthcare need.

Referral criteria include:

• High comorbidity of physical and mental health conditions
• Frequent GP or emergency department attendance
• Long-term pain or medically unexplained symptoms
• High opioid, benzodiazepine or gabapentinoid use
• Strong clinical suspicion of trauma-related illness

The programme aims to develop more compassionate, effective and sustainable approaches to complex care.

Homeless Health Research

Research linked to the Adelaide Surgery homeless outreach service and the PL1 project has explored the interface between hospital and community services for homeless and socially excluded populations.

Initial work identified:

• Much higher emergency department attendance
• Increased inpatient admissions
• High rates of self-discharge
• Increased missed outpatient appointments
• Significant barriers to engagement with care

This work continues to inform service development and partnership approaches across Plymouth.

Community Wellbeing Initiatives

Plymouth Deep End contributes to community wellbeing projects that bring together healthcare, voluntary organisations and local communities.

Examples include:

• Feel Good Friday
• Stonehouse Health Village
• The West End Health & Wellbeing Hub
• Partnership work with social prescribing and voluntary sector organisations

These projects support prevention, connection and improved access to health and wellbeing services.

Deep End Education

Deep End practices in Plymouth support teaching and placements for:

• Medical students
• GP trainees
• Nursing students
• Occupational therapy students
• Clinical psychology trainees

Educational development work focuses on improving understanding of:

• Health inequalities
• Complex multimorbidity
• Trauma-informed care
• Substance misuse
• Inclusion health
• Community-centred healthcare

Working Collaboratively

Plymouth Deep End works collaboratively with:

• GP practices
• Universities and academic departments
• Public health teams
• NHS organisations
• Community and voluntary sector organisations
• Researchers and students
• People with lived experience

We believe meaningful research should be collaborative, practical and shaped by the communities it aims to support.

Research, Advocacy and Systems Change

Research at Plymouth Deep End is closely connected to advocacy and service development.

We aim not only to understand health inequalities, but also to influence policy, improve services and support fairer healthcare systems.

Our work contributes to:

• Developing equitable models of care
• Supporting trauma-informed systems
• Highlighting the impact of deprivation on health
• Improving access for marginalised populations
• Strengthening community-based healthcare
• Supporting workforce resilience in deprived areas

Get Involved

We welcome collaboration with:

• Researchers
• Students and trainees
• Healthcare professionals
• NHS organisations
• Public health teams
• Community and voluntary organisations
• Funders and partner organisations

Potential opportunities include:

• Collaborative research projects
• Service evaluation
• Quality improvement initiatives
• Student placements
• Community-based participatory research
• Health inequalities and inclusion health projects

To find out more about research, partnership or educational opportunities within Plymouth Deep End, please contact us.

Useful Links & Resources

Deep End & Health Inequalities

GPs at the Deep End (International)
https://www.gla.ac.uk/schools/healthwellbeing/research/generalpractice/deepend/international/

Institute of Health Equity
https://www.instituteofhealthequity.org/

Trauma-Informed Care Resources
https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/

Trauma-Informed Practice Toolkit Scotland
https://www.gov.scot/publications/trauma-informed-practice-toolkit-scotland/documents/

GPs at the Deep End Bristol – Research
https://deependgps.bristol.ac.uk/research/