Background People with severe and multiple disadvantage (SMD- combinations of homelessness, substance misuse, violence, abuse and poor mental health) have high health needs and poor access to primary care. Aim To explore perceptions and experiences of improving access to general practice for people with SMD in healthcare staff and people with lived experience. Design and Setting Bridging Gaps is a collaboration between healthcare staff, researchers, women with lived experience of SMD and a charity that supports them in a UK city. We co-produced a project to improve access to general practice for marginalised patients, that was further developed with 3 inner city general practices. Method We observed six collaborative service improvement meetings at three general practices and conducted documentary analysis of minutes of a further three meetings. We interviewed nine practice staff and four participants with lived experience. Three participants with lived experience and one staff member who supports them participated in a focus group. Data was analysed inductively and deductively using thematic analysis. Results Enabling motivated general practice staff with time and funding opportunities, galvanised by lived experience involvement, resulted in sustained service changes. These included: care coordinators and patient lists to support access to patients in greater need and an information sharing tool. The process and outcomes improved connections within and between general practices, support organisations and marginalised patients. Conclusion These co-produced strategies could be locally adapted and evaluated elsewhere. Investing in this different way of working may improve inclusion of marginalised groups, health equity and staff wellbeing.

The authors have declared no competing interest.

Bridging Gaps received funding through the Q Exchange by the Health Foundation and NHS England and NHS Improvement and National Institute for Health and Care Research (NIHR); Research Capability Funding through the NHS Bristol, North Somerset and South Gloucestershire CCG grant number RCF20/21-1LP; the NIHR School for Primary Care Research grant number 465; the National Institute for Health and Care Research (NIHR) Applied Research Collaboration West (NIHR ARC West) and the National Institute for Health and Care Research Bristol Biomedical Research Centre. LP was supported by the Wellcome Trust grant number 23501/Z/21/Z. GF's salary was supported by the UK Prevention Research Partnership (Violence, Health and Society; MR-VO49879/1), an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England) and the UK devolved administrations, and leading health research charities. The views expressed in this article are those of the authors and not necessarily those of the NIHR, the Wellcome Trust or the Department of Health and Social Care.

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This research was granted approval by the University of Bristol Faculty of Health Sciences Research Ethics Committee, references 93802 and 110882. Health Research Authority approval REC reference: 21/HRA/5057.

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