Poverty proofing Doncaster primary care mental health 2026

Poverty proofing delivery partner model

Children North East are working in partnership with Rotherham, Doncaster and South Humber (RDaSH) NHS Trust to fulfil its ambitious promise to “poverty proof” all of its services by December 2025. The trust has committed to piloting a bespoke Delivery Partner Model developed in partnership with Children North East (CNE).

Poverty Proofing is a nationally recognised tool, designed to educate and enable health care professionals to identify, acknowledge, and reduce the impact of poverty, advocating for equality of access to healthcare, services and technologies that contribute to overall health outcomes experienced by those living in poverty.

A locally trained team (LTT) of people have been trained and are being supported by Children North East to carry out this work in line with the ethos and principles of poverty proofing.

• Phase 1: 3 model audits carried out by Children North East
• Phase 2: a further 6 audits carried out by the locally trained team with support from Children North East
• Phase 3: all other trust services will engage in the poverty proofing process during 2025 and 2026. Children North East will deliver training to all staff; the locally trained team will carry out scoping of services and engage patients and staff in consultations; and the trust strategy team members will deliver feedback and write reports for each service. Moving forward, services will become more poverty informed, learning how to work with their patients to identify barriers, so that poverty becomes everyone’s business, and no-one is left out or left behind

This whole system approach is unique and has accountability at every level and a commitment to alleviate barriers that apply across the whole system.

Poverty proofing Doncaster primary care mental health

The primary care mental health hub (PCMHH) provides recovery focused, National Institute for Health and Care Excellence (NICE) recommended psychosocial support for adults (aged 18 and over) experiencing moderate to severe mental health difficulties that can be safely managed within a community setting. Operating primarily through clinic based appointments, the primary care mental health hub aims to offer timely access to care, with an ambition to see individuals within four weeks and provide support for up to six months. The service delivers a wide range of psychological and wellbeing interventions through a multidisciplinary workforce, including mental health practitioners, low and high intensity therapists (such as cognitive behavioural therapy
and eye movement desensitization and reprocessing), peer support workers, community connectors, and employment specialists. The primary care mental health hub focuses on assessment, brief interventions, structured psychological therapies, and social prescribing, while also signposting and connecting individuals to appropriate local services to meet wider needs.

The primary care mental health hub supports people whose needs do not require medication changes, crisis response, or long term care coordination, and acts as an enhanced primary care offer for individuals with complex or moderately severe mental health presentations. This includes people with diagnosed conditions whose needs cannot be met by NHS Talking Therapies alone, those managing complex emotional needs without immediate risk, and individuals who frequently attend GP services where mental health is an underlying factor. By working closely with primary care networks and community partners, the primary care mental health hub strengthens early intervention, improves access to mental health expertise within primary care, and helps reduce pressure on secondary care services while promoting stability, recovery, and social inclusion.

Poverty proofing ethos

No activity or planned activity should identify, exclude, treat differently or make assumptions about those whose household income or resources are lower than others.

Voice

The voice of those affected by poverty is central to understanding and overcoming the barriers that they face.

Place

We recognise that poverty impacts places differently, and so understanding place is vital in our response. Organisationally we also need to be clear about why and how decisions are made. This understanding of context is essential.

Structural inequalities

The root causes of poverty are structural. What structural changes can we make at an organisational level to eliminate the barriers that those in poverty may face?

Poverty proofing process

Stage 1: training and consultation with staff

Staff were invited to attend the 3-hour training on poverty proofing from January to March 2026 and 12 staff members attended

Stage 2: scoping

Time was spent gathering information about the service and how it works and consultation were held with 6 staff.

Stage 3: patient and community consultations

We received verbal feedback from 6 individuals, and we received 30 questionnaires.

Stage 4: feedback session

A feedback session was held with Barbara Taylor, Service Manager and Joanne Goulding, Clinical Team Lead where findings were discussed, and changes were collaboratively discussed that could be implemented.

Stage 5: review

Around 12 months after completion, the trust will complete a review identifying good practice and potential considerations.

Common themes

The next sections of this report highlight the most common themes to come out of the poverty proofing consultations. For each theme the report covers:

• what works, what you do now that supports those experiencing poverty
• the barriers and challenges faced by those experiencing poverty
• recommendations, each recommendation comes with a set of considerations for “poverty proofing” the service

The themes are presented alphabetically, and this does not imply any hierarchy of importance. The themes for Doncaster primary care mental health were:

• communication
• health-related costs
• navigating and negotiating appointments
• patient empowerment
• staff awareness and guidance
• travel

Communication

Communication is important to consider in Poverty Proofing both from a health literacy perspective of how information is communicated and understood and in ensuring there are reciprocal lines of communication between services and service users. O’Dowd (2020) reported that availability of care was a particular concern for those on a low income and there were significant inequalities in care availability for the most deprived areas. Communication is a key factor in ensuring availability of care.

What works

Clear and compassionate communication

Patients described communication from the service as clear, supportive, and compassionate. Appointment letters were generally easy to understand, and patients valued receiving information in advance, including details about their conditions and treatment options. Clear written communication, combined with flexible approaches to appointment changes, helped patients feel well informed and respected. Many also appreciated having some choice over where appointments took place, which contributed to a more person centred experience.

Supportive and welcoming patient experience

Patients consistently reported that primary care mental health services felt welcoming, friendly, and supportive. Follow up telephone calls and appointment reminders via phone and text message were particularly valued, as they helped patients feel supported and reduced the likelihood of missed appointments. Positive interactions with staff, described as warm and reassuring, further reinforced patients’ confidence in the service and enhanced their overall experience

“Letters I have received have been easy to understand.” (Patient)

“People are understanding.” (Patient survey)

“Appointments have been followed up by telephone calls which is great.”

“Made to feel at ease.”

“People are understanding.”

“I have been provided with information about my condition, and I am given the opportunity to go through any information I don’t really understand.”

Barriers and challenges

Gaps in communication and awareness

Despite many positive experiences, patients and staff highlighted gaps in communication and awareness. Some patients were unclear about how to contact the service directly or how to provide feedback, and feedback mechanisms were not always visible or routinely shared. There was also limited patient awareness of available support, including wider community services and culturally appropriate considerations within care planning.

Access barriers and administrative risks

Many patients reported limited understanding of financial, travel, and prescription support linked to healthcare access, including transport assistance and wider social support options. Digital exclusion, such as limited access to devices, data, or Wi Fi, was identified as a barrier to engagement for some individuals. Staff also raised concerns about risks within current administrative processes, particularly around appointment changes and internal task systems, which may impact consistency and clarity of communication.

“I have never been given details on how to contact the service directly.”

“Clean space and welcoming staff who are considerate to my needs”

“It would be great if there was a way for me to give feedback to the service.”

“I have never been asked about cultural perspectives.”

“I wasn’t aware that there is the option to get free bus passes to patients to attend appointments. I have only become aware from this questionnaire that there is support for NHS prescription, travel cost and those on low income.”

Recommendations for communication

Consistent transparent communication

• Establish a standard communication approach across the service, including direct contact details, appointment duration expectations, cancellation guidance, and clear feedback routes.

Accessible information on financial and practical support

• Provide clear, proactive information about financial help, travel costs, prescriptions, and community support at first contact and key points in care, including a dedicated poverty support information pack.

Inclusive accessible formats

• Ensure all information is available in easy read formats, multiple languages, and both digital and printed versions, while addressing the needs of people with low literacy or limited digital access.

Visibility and use of feedback mechanisms

• Make feedback processes clearly visible and easy to access through waiting areas, appointment letters, and digital communications.

Culturally responsive care and communication

• Embed discussion of cultural needs into assessments and support staff with guidance to enable culturally competent, sensitive conversations. Encourage uptake of cultural competency training on electronic staff record (ESR) for staff.

Administrative communication

• Review and strengthen internal administrative systems to reduce missed tasks, prevent delays, and improve appointment management and continuity of care.

Health related costs

“Money buys goods and services that improve health; the more money families have, the more or better goods they can buy.” (Joseph Rowntree Foundation, How does money influence health? 2014).

The Food Foundation (2023) found that in order for the poorest fifth of the population in the UK to meet the Government recommended healthy diet guidance they would need to spend half of their disposable income, compared to just 11% for the least deprived fifth.

What works

Limited financial impact on patients

Most patients reported that they did not have to pay directly for mental health care and had not incurred significant healthcare costs through the service. Flexible appointment scheduling, including availability during school hours, helped reduce additional expenses such as childcare costs. Where financial support was discussed, some patients were successfully supported to access prescription cost assistance and benefits advice, helping to further minimise financial barriers to care.

Awareness of support schemes and external partnerships

Some patients demonstrated awareness of support schemes such as prescription support and low income schemes, although this was not universal. Staff identified the importance of strengthening links with external support agencies, including organisations like Citizens Advice, to improve signposting and ensure patients are better informed about the financial and practical support available to them.

“I have not needed to pay for anything other than fuel to get here.” (patient)

“I’ve never had to purchase anything for my healthcare with this service.” (patient)

“It’s great that I can get appointments when kids are in school and it doesn’t mess up my school run time.” (patient)

“It’s great that we can now refer to Citizens Advice.” (colleague)

Barriers and challenges

Financial barriers to accessing care

The data highlights that financial hardship continues to affect access to primary care mental health services for some patients. Reported pressures include prescription charges, travel costs, childcare responsibilities, and wider costs associated with attending appointments. Prescription charges in particular remain a significant burden, with patients describing difficulties affording regular medication. Travel costs (fuel, buses, taxis) and the need to arrange or pay for childcare further compound these barriers, occasionally resulting in delayed or missed appointments

Gaps in financial conversations and support awareness

The data also indicates that financial pressures are not routinely or proactively discussed within appointments. Many patients reported that conversations about costs only occur if they raise the issue themselves, and some feel embarrassed or uncertain about doing so. There was notable variation in awareness of available financial support schemes, including prescription exemptions and travel assistance, suggesting that support is not being communicated consistently. This highlights a need to normalise financial conversations and improve proactive sharing of information about available help.

“I would feel embarrassed.” (Patient)

“Have to pay for regular prescriptions.” (patient)

“I’ve never had a discussion about any health-related costs, it never comes up.” (patient)

“If it wasn’t for being able to get my appointments during school hours, I may have to find childcare.” (patient)

“Offer discount or free services and give clear information of available support.” (patient)

“I hope to be able to build curious questions into assessments in a respectful way.” (colleague)

“I want to Learn more about it, understand what can do to help, signposting.” (colleague)

Recommendations for health related costs

Financial wellbeing conversations and provisions

• Proactively discuss hidden cost of healthcare with patient to find out where these are to be able to support
• Share information on prescription exception available or option to reduce prescription costs
• Share where required the RDASH travel fund support available to patients to attend appointments
• Normalise and embed discussions about financial pressure as part of holistic assessments using prompts to sensitively explore financial barriers.
• Make information about financial support highly visible and accessible through waiting areas, appointment letters, and proactive conversations, rather than relying on patients to ask.

Financial and welfare support referrals

• Referral to Doncaster Citizens Advice for patients.
• Ensure all staff understand and can confidently explain the NHS Low Income Scheme, prescription support, travel reimbursement schemes, community grants, and local hardship funds.
• Develop and promote defined referral routes to food support, debt advice, and housing support.
• Consider embedding social prescribing or welfare advice more closely within primary care mental health pathways to address financial stressors alongside clinical care.

Navigating and negotiating appointments

Life can be particularly unpredictable when living on a low income. The challenges, for example around childcare or zero hours’ contracts can make attending appointments very difficult. Pressures on the NHS around waiting times and stretched services can mean there is little scope for flexibility and strict discharge policies are applied for those who miss appointments, effectively severing access for those with changeable circumstances. Furthermore, social problems often accompany poverty, and sometimes life can be chaotic, which makes consistent appointment attendance difficult. Availability and flexibility of care are important for improving access to health care for those on a low income.

The King’s Fund (2021) report states that:

“Services need to be flexible, accessible, responsive and offer continuity of care.”

What works

Flexible and accessible appointments

Patients consistently value the flexibility offered around appointment timing and location. Being able to attend appointments during school hours, choose local venues, or access phone appointments helps reduce childcare, travel, and other associated pressures. This flexibility supports better engagement by fitting around work, family, and personal commitments, while telephone appointments also help minimise costs for some patients.

Responsive and community based care

Positive experiences highlighted include having a choice over appointment locations and times, quick access following crisis referrals, and responsive follow up through telephone reminders and calls. Patients particularly appreciate services being delivered within local communities, describing this approach as more convenient, reassuring, and supportive of ongoing engagement with care.

“Choice was given for when my appointment would be.” (patient)

“Being able to choose the location that I attend for my appointment is beneficial.” (patient)

“I was seen within three weeks of attending crisis.” (patient)

“It’s easy to get here, I only must get one bus.” (patient)

“See patients closer to their home.” (colleague)

“Access to more clinic spaces in the community.” (colleague)

Barriers and challenges

Although the above, when staff were asked which poverty-related barriers apply to patients accessing services over 60% of staff survey respondents informed:

• complex health systems (difficult to navigate, referrals appointments)
• hidden costs of appointments (time of work, childcare, missed free school meals)
• travel and transport (cost of parking, public transport, taxi’s)

Logistical barriers to access

Patients identified several practical challenges that can make accessing appointments more difficult, including childcare responsibilities, the need to take time off work, travel burdens, and reliance on family support. Administrative delays and limited awareness of available support further compounded these pressures. Some patients reported lacking sufficient detail about appointments, such as expected length, which made planning around work, travel, and caring responsibilities more challenging.

Administrative and system related challenges

Both patients and staff highlighted complexities in booking, changing, and cancelling appointments. Task based administrative systems were identified as a risk, with concerns that important information or clinician actions could be missed, particularly when staff are unavailable. Staff also raised issues with appointment cancellation processes, noting potential impacts on continuity of care and efficiency if systems are not robust or clear.

“I had to take time off work to bring my child to the appointment.” (parent)

“Would have preferred being given an idea of how long the appointment would be.” (patient)

“There is a danger when tasks are sent to a clinician directly and if they don’t see them.” (colleague)

Recommendations for navigating and negotiating appointments

Complex health systems appointment

• Streamline booking and cancellation processes and review systems to ensure resilience and continuity, particularly during staff absence.
• Consistently communicate estimated appointment lengths to help people plan and reduce anxiety or disruption. This can be on appointment letters or on text confirmations.
• Provide support for digital navigation and increase the use of phone appointments alongside community-based location to improve access and convenience (apps and booking systems).
• Consider needs of parents and carers and families when scheduling appointments offering additional flexibility and support where possible.

Page last reviewed: June 02, 2026
Next review due: June 02, 2027

Problem with this page?

Please tell us about any problems you have found with this web page.

Do not include personal or medical information in your message. For example, NHS number, date of birth or medical history.

Type of problem -- Please choose an option -- Wrong information Accessibility Spelling or grammar Layout or display Other

Please provide details of the problem

If you would like us to contact you about your issue, please enter your contact information below.

Your name (optional)

Your email address (optional)

Your phone number (optional)