{
  "abstract": "Background Deep End practices serve communities experiencing high levels of socioeconomic disadvantage and complex patient need. The North East and North Cumbria Deep End Network of General Practices (NENC DEN) developed the CareDEEP intervention to enable practices to provide support around the wider determinants affecting the health and wellbeing of their patient populations. CareDEEP provides autonomy and flexibility for practices to choose to use financial support (£38,000 per practice) to design and implement initiatives focusing on non-medical needs of their patient populations. Peer support and opportunities for reflective learning for participating practices are built in. 11 practices in NENC DEN took part in the first wave of CareDEEP (April 2024 to April 2025). We undertook a realist evaluation to understand how CareDEEP works – what it does, who it works for (or not) and why, and identify contextual factors which impact on the intervention.Methods Data collection included document review of 10 expressions of interest forms and 17 quarterly monitoring reports submitted by participating practices; observations (approx 17 hours) at peer support meetings, networking meetings and in practice settings; interviews (n = 21) and one focus group (4 participants) with staff involved in CareDEEP. Data generation and analysis were conducted iteratively, using Nvivo for data management and analysis.Results Three typologies of approaches emerged which varied in the extent to which they departed from biomedical framing and ways of working to support wider determinants of health. Firstly, initiatives focusing on improving patient engagement with preventative measures (i.e. increasing uptake of screening and immunisation); secondly, initiatives aimed at adapting practice settings to facilitate better patient engagement (i.e. improving communications with patients, staff development through health literacy awareness), and thirdly outward facing initiatives seeking to address wider aspects of patients’ lives (e.g. supporting development of community activities).Contexts of participating General Practices including passions and prior exposure of practice staff to thinking about wider determinants of health, and relationships with services outside the practice, are a precursor that influenced the type of approach adopted by practices. When introduced into settings with established public health ethos and existing community relationships, CareDEEP triggered mechanisms including feasibility, familiarity and commitment, leading to the observed types of initiatives.Conclusion General practices conceptualise and operationalise the opportunity to provide support around the wider determinants of health differently and prior context is important. These findings are informing the development of subsequent phases of intervention roll-out across other NENC DEN member practices.",
  "authors": [
    {
      "affiliations": [
        "Population Health Sciences Institute, Newcastle University, Newcastle, UK"
      ],
      "name": "Mihirini Sirisena"
    },
    {
      "affiliations": [
        "Chopwell Primary Health Care Centre, North East and North Cumbria Deep End Network, Gateshead, UK"
      ],
      "name": "Alisha Gupta"
    },
    {
      "affiliations": [
        "Chopwell Primary Health Care Centre, North East and North Cumbria Deep End Network, Gateshead, UK"
      ],
      "name": "Sameena Hassan"
    },
    {
      "affiliations": [
        "Chopwell Primary Health Care Centre, North East and North Cumbria Deep End Network, Gateshead, UK"
      ],
      "name": "Sarah Sowden"
    }
  ],
  "title": "P66 Addressing wider determinants of health within deep end general practices serving communities experiencing high levels of socioeconomic disadvantage: the CareDEEP initiative",
  "uid": "79bddeba-7771-5bd9-ae7f-b5333c06766e"
}