There have been major changes in modalities of both access and provision in general practice.1 Delivery of general practice is unrecognisable compared with several years ago. General practice is experiencing the repercussions of the COVID-19 pandemic, increased digitalisation of services, implementation of primary care additional service roles through the Additional Roles Reimbursement Scheme (ARRS), austerity cuts, and continued challenges in staff recruitment and retention. In response, practices have sought to address these challenges with ever-changing, increasingly complex access routes, software platforms, and reorganisation of services.

Achieving safe, quality care for those already disadvantaged remains harder than ever.2 We argue that new (largely remote) models are exacerbating the already felt inequalities in access and quality of care.

New models of primary care prioritise access for those who are digitally literate, able to navigate complex online systems or apps, are verbally competent, or well supported. Simply increasing the digitalisation, without addressing these issues, risks exacerbating inequalities.3 The impact of increasing digitalisation on the most vulnerable such as those living in poverty, people with learning disabilities or neurodiversity, those with poor literacy skills or poor English, and isolated older adults has been under-recognised, with insufficient mitigations put in place.

In the context of austerity, life expectancy and healthcare provision has worsened for the most vulnerable.4,5 The Dhalgren–Whitehead ‘rainbow model’ of health determinants6 revolutionised understanding of the determinants of health, incorporating the importance of societal and policy factors, alongside provision of health care. Yet, in keeping with the inverse care law, inequities in the quality and safety of patient care are continuing to grow.1

Recent research …