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General practitioners occupy a key position in the NHS, as both the major providers of care and as the gateway into secondary and tertiary services. General practice is the most widely distributed and accessible of all NHS services, and most people are registered with a general practitioner (GP). Recent changes in the organisation and funding of the NHS has underlined their key role in strategies to promote health and tackle health inequalities. Yet little is known about how GPs address health inequalities in their day-to-day practice.

The Programme appointed a general practitioner principal with Camden and Islington Health Authority, Dr Satinder Kumar, to a User Fellowship, to focus on GP perceptions of health inequalities. The Fellowship had two aims (i) to increase GP's awareness of health inequalities and health inequalities research and (ii) to conduct an exploratory study of how inequalities are managed in the micro-context of general practice.

The first aim was achieved through links with professional bodies representing and serving general practitioners: the Royal College of Practitioners, including input into the RCGP health inequalities sub-committee and a presentation at the RCGP themed conference on health inequalities (June 2001), and the Wessex Research Network (WreN), including an article in the WreN newsletter (summer 2000) and a presentation at the annual research day (May 2001). Additionally, the research findings were presented and discussed with several general practices in Basingstoke (November 2001) at their annual research meeting.

The second aim involved a qualitative study of 25 GPs, selected from towns and cities across England, and interviewed in their surgeries. The study indicated:-

• high levels of awareness that health inequalities are grounded in social inequality. GPs however differed substantially in their ability to develop strategies for managing health inequalities.
• strategies included interventions at patient level (intervening to help resolve housing problems and increasing benefits), at practice level (providing taxi services for lone parents to attend surgery, providing counselling that addresses the social/material influences on wellbeing) and at community level (supporting community action around playground safety and food availability in local shops).
• successful management of health inequalities requires a cultural competence, an ability to read and integrate knowledge of patients' social context within the consultation, and skills in advocacy. These capacities have the character of a 'health inequalities speciality ' and are developed over time.