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CPD: How to develop a culturally competent practice

Key points

  • Cultural competence is the ability to communicate and interact effectively with people from other cultural backgrounds – which in primary care means delivering effective, quality care to patients who may have diverse beliefs, values, attitudes and behaviours
  • Electronic health records can provide valuable information about cultural demographics, which helps identify service gaps and areas that require more attention and resources
  • A diverse PPG can help the practice better understand cultural dimensions
  • Fostering an environment of cultural competence can help your practice achieve the CQC’s ‘culturally competent care’ requirement and may also help QOF scores and immunisation targets
  • Integrate cultural competence into staff training and ensure you have a culturally diverse workforce

Dr Meena Nathan is GP clinical lead for Grenfell and Krishna Sarda is head of engagement for North Kensington Recovery at North West London ICS

Cultural competence is the ability to communicate and interact effectively with people from other cultural backgrounds. For GPs and practice staff, this means delivering effective, quality care to patients who may have diverse beliefs, values, attitudes and behaviours.

Following the 2017 Grenfell Tower fire in London, which largely affected people from Black, Asian and minority ethnic communities, it became clear to local commissioners that we needed to widen our understanding of cultural differences to address the complex health needs of our patients.

So North London ICS ended up creating our cultural competence training, which recently received RCGP accreditation. This was the result of a two-year process of whole-system partnership with local communities in North Kensington, including those impacted by the Grenfell fire. 

Patients shared their views on how our health services could be more culturally relevant. The need for clinicians to have a better understanding of cultural manifestations of grief and bereavement was a top priority, as were interventions to support women to break the taboo about menopause. 

While the needs of every patient population will vary, cultural competence is a foundational pillar for reducing disparities through culturally sensitive and unbiased quality care.

Healthcare inequities are often experienced in communities like those in North Kensington, where the barriers to access can be poorly understood. In order to achieve equity of outcomes, some groups may need more or different support or resources. Developing cultural competence in primary care will go a long way to understanding the factors that can lead to inequities, and how to address them.  

Here is advice on how to develop a greater cultural awareness in your practice.

1: Use your data to improve understanding of patient needs
Properly and diligently coded electronic health records are the first step to understanding your cultural demographics. Used with your disease register – and perhaps augmented by external sources such as the Office for National Statistics (ONS) and local surveys – these will provide evidence about health conditions, beliefs and behaviour by ethnicity and gender. 

This will mean you are better informed to review uptake of screening and vaccines, look into missed appointments and ensure patients with long-term conditions are being followed up. 

Here in North Kensington we used the West London disease register to source information. In your area, the PCN profile packs should help this process by providing specific data. These data will help you build a picture of service gaps and identify areas that require more attention and resources.

Data analysis of patients with long-term conditions, such as type 2 diabetes, has shown that certain ethnic communities in North Kensington – Black, South Asian, Somalian and Arab – face more challenges when managing symptoms because of the way culture shapes their understanding of disease, illness and sickness. 

For example, some patients are not aware that consuming a lot of rice raises blood glucose. To combat such misinformation, we developed diabetes education workshops that focused on food as medicine, explaining how certain diets are heavy in carbohydrates and how this correlates with the management of diabetes.

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