Health justice, digitalised primary care services and Intersectionality: Racialized minorities in the UK

Racialised inequalities in access and use of primary care services can result in delays in diagnosis, treatment and referrals to more specialized services. The rapid transformation of primary care services through recent processes of digitalisation in the UK have been accelerated by the pandemic and provide a timely opportunity for investigating the fairness of primary care services as perceived by racialized minorities in the country at a critical juncture. Drawing on critical realism, we use a novel feminist intersectional approach to investigate and identify clusters of ‘constraints’ and ‘enablements’ operating within both the home and in general practices. We apply this approach to in-depth analysis of 100 interviews with racialized minorities, targeting Africans, Caribbeans, Chinese, Bangladeshis, Indians and Pakistanis in four case study sites in the UK, using a purposeful sampling strategy to reflect diversity in age, gender as well as ethnicity. We draw on three commonly used criteria in procedural justice, namely, voice, trust and impartiality. Our results indicate that processes of transformation of primary care services are falling seriously short on these criteria and are increasing the challenges that racialized minorities face in accessing and using these services. Urgent action is required to avoid the deepening of existing ethnic disparities in healthcare and health equity. Further, deeper appreciation of the complex ways in which ethnicity, gender, age, low income and migration trajectories intersect with each other and the health system is needed to improve access to, and experiences of these services