Health 
On September 9 2026, Policy Connect and the All-Party Parliamentary Health Group (APHG) published ‘First Point of Care: A Plan for a Better NHS Front Door Through Connected Primary Care’. The report examines the barriers people face to accessing general practice, community pharmacy, NHS dentistry and optometry, and what change is needed to overcome them. The inquiry looked at all four sectors together, reflecting the way patients experience primary care in practice: not as four separate systems, but as different parts of the same front door to the NHS.
The inquiry was supported by the Institute of Public Health and Wellbeing at the University of Essex and Primary Health Properties. The Institute brings together research on the multiple causes of ill-health and health inequalities with the University’s wider civic mission, linking evidence to policy, service design, and local action. A key example of this work that informed the APHG inquiry is the Institute’s Centre for Coastal Communities (CCC), which works with local communities, policymakers and frontline professionals to ensure that the research questions it asks, the data it generates, and the solutions it develops are informed by and for coastal communities. That work connects closely with the University’s Health, Wellbeing and Care Hub, which through a similar model, combines community-facing services, workforce development, and research with NHS and local partners. In our report, the Hub is one example of how community anchor institutions can add capacity to primary care while keeping services responsive to local needs.
Prior to the launch, I sat down with Professor Mariachiara Di Cesare, Director of the Institute of Public Health and Wellbeing, to discuss why the Institute supported the inquiry, how its research and community-facing work connects with the report’s findings, and what she hopes policymakers will do next.
Universal access does not mean equal access
For Professor Di Cesare, supporting the inquiry was a natural extension of the Institute’s purpose. Its work focusses on generating robust evidence that can inform practical action, particularly where structural barriers contribute to unequal health outcomes.
“We are committed to answering difficult questions, challenging what we know about problems and generating robust evidence that can improve people’s lives. The inquiry into improving access to primary care provided exactly the opportunity to translate that commitment into action by addressing the structural factors affecting access to primary care, including those driving inequalities in access and health outcomes.”
This connects directly to one of the report’s central themes: universal access does not necessarily mean equitable access. Although primary care in the UK is free at the point of use, many people still face barriers to accessing timely and quality care that meets their needs. While others are missed by national measures of access altogether because they are not registered, have stopped trying, or never make it far enough into the system to be counted.
“In the UK, primary care is universally available and free at the point of use, but the evidence shows significant inequalities in access to and use of primary care services. Some groups face greater barriers, including geographical, socioeconomic, digital, cultural, and administrative obstacles. As a result, those with the greatest needs are often the least able to access timely care, which can widen existing inequalities in access and health outcomes.”
Professor Di Cesare made a similar point when reflecting on the report’s alignment with wider work by the World Health Organization (WHO) on access to healthcare. While the UK is in a relatively privileged position in having universal primary care that is free at the point of use, this can create a false sense that the access question has already been solved.
“Once you think you have universal access to primary care, free access, then you think it’s done, but it’s not done.”
That distinction is closely aligned with the inquiry’s own starting point. Improving access means more than increasing the number of appointments. It means understanding who is not getting in, who is being missed by existing measures, and which barriers need to change if universal provision is to become genuinely equitable in practice.
From research to services: the university as a community anchor
Much of our conversation then turned to what universities and civic institutions can do to help reduce the health inequalities produced by barriers to primary care access. Professor Di Cesare was clear that to implement lasting change, research institutes should not see policy impact as something that happens only after a project is finished.
“At the University of Essex and within the Institute, our research is designed from the beginning to inform policy, service design and decision-making. It helps stakeholders develop the interventions they need to improve health and wellbeing outcomes. As a civic institution, we also work very closely with communities and regional partners, so that our work is not simply an academic exercise but is embedded in the needs of the region.”
That approach mirrors one of the findings running through First Point of Care. The inquiry identified organisations outside the NHS that are already reaching people who are oftentimes missed by mainstream primary care services. Universities, hospices, and community organisations are providing additional services, training staff and working directly with local populations, but often without a standing route through which the NHS can commission or scale what they do.
The University of Essex Health, Wellbeing and Care Hub is one of the clearest examples of this in the report. It combines three functions that are too often treated separately: workforce development, community service provision, and research embedded in everyday practice. The Hub works with NHS England, Integrated Care Boards and local partners, while its services are shaped around the needs of the communities they serve.
“A critical element of the Hub that it is not only about delivering services: it also trains the workforce and develops research that can inform those services. Because the services are place-based and embedded in the community, they can respond to local needs and be shaped around the areas of highest need. It is not simply about what academics think is important, but what the local community needs.”
That relationship with the community also gives the Hub a wider role beyond the frontline services it delivers. By working closely with the people using those services, it can help surface unmet need and generate evidence that can guide reform to primary care services elsewhere in the system.
“Because services such as the Hub are so embedded in the community, the lived experience of the people who use them is fundamentally important in shaping how the service works. Their closeness to the community also means they can help identify where needs are not being met and use that knowledge to inform other services, not only those delivered within the Hub.”
This is especially relevant to Recommendation 12 of the report, which calls on the Department of Health and Social Care to enable community anchor institutions to complement existing primary care provision. The recommendation focuses on functions such as workforce training, research coordination, service integration, and the use of anchor institutions’ facilities where appropriate.
Professor Di Cesare framed the University of Essex in exactly those terms: a civic university and an anchor institution whose contribution comes through education, research and partnership. But she was equally keen to reject a one-way idea of ‘knowledge transfer’, where expertise simply moves from the university out into the community.
“There is a wealth of knowledge coming from the community and the organisations within the community that is transferred to the university. It’s truly a dynamic feedback of knowledge and information from one to the other.”
That two-way relationship is central to the Institutes model. Universities can contribute research capacity, specialist expertise and future workforce development, but communities and local organisations bring knowledge about where services are failing, which needs are changing, and what practical solutions are likely to work. First Point of Care argues that models like this should complement rather than destabilise existing NHS provision. The challenge is therefore not simply to find more good local examples, but to create commissioning and partnership arrangements that make it easier for effective local service provision to be repeated without relying on local goodwill or one-off relationships.
The case for acting now
Rounding off our conversation, Professor Di Cesare returned to what she sees as one of the report’s strongest features: its 13 recommendations are not merely demands for additional funding. Rather, seven can be implemented within existing resources and redeployment of funds, while a further three can be delivered primarily within existing resources.
“The central message of the report is that improving access to primary care is both achievable and necessary.”
That does not mean primary care does not need further investment. The inquiry is clear that it does. But many of the changes it proposes concern how existing resources are distributed, how services are commissioned, how organisations work together, and whether policymakers are willing to change arrangements that are producing unequal access.
For Professor Di Cesare, that makes implementation as much a question of leadership as finance. The evidence base is there, the barriers are identifiable, and many of the practical routes forward are already available.
“I hope policymakers take the opportunity to make bold, evidence-based decisions and act to address the barriers to primary care.”
The outcome she wants is straightforward: a primary care system that is more equitable, sustainable, and responsive to the needs of the communities it serves. The report provides a clear, practical, and achievable route towards that. The next step is action.
Read the full ‘First Point of Care’ report here: First Point of Care: A Plan for a Better NHS Front Door through Connected Primary Care – Policy Connect
Find out more about our Health policy work by contacting the report’s author Jasmin Adebisi (jasmin.adebisi@policyconnect.org.uk)
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