Beyond Core20PLUS5: What Communities Need from the NHS to Reduce Health Inequalities

What does Core20PLUS5 cover?

Core20PLUS5 identifies a target population and five clinical priorities for accelerated improvement. “Core20” refers to the most deprived 20% of the population, and “PLUS” covers groups identified locally – explicitly including ethnic diverse communities. The five clinical priorities are maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis, and hypertension case-finding. On maternity specifically, the framework calls for continuity of care for women from Black, Asian and minority ethnic communities.

This matters as it gives systems a shared language and clear national priorities. But it’s a targeting framework.. It tells systems where to focus, not how to build the trust needed to close the gap.

Where the gap still sits

Being named in a “PLUS” group doesn’t automatically translate into an ethnically diverse patient trusting their GP, understanding their diagnosis, or feeling safe disclosing a mental health concern. That gap sits in the detail a national framework can’t specify locally and it’s where most of the actual inequality persists.

Trust has to be built before data can be acted on. Ethnicity coding and case-finding only work if people are willing to engage with services in the first place. In many South Asian and ethnically diverse communities, mistrust of statutory services which are often rooted in past experience, language barriers, or feeling unheard means people disengage long before Core20PLUS5 can identify them.

Culturally competent staff, not just culturally aware targets. Hitting a target for hypertension case-finding or cancer diagnosis requires frontline staff who understand how symptoms are described or minimised differently across cultures, and who can hold sensitive conversations around mental health, maternity, or end-of-life care, with cultural and religious context in mind.

Language access that goes beyond interpreting services. Booking an interpreter isn’t the same as making a service genuinely accessible. Health information, consent processes and self-management guidance often still assume English fluency and health literacy that many patients, particularly older generations, don’t have. 

Community-led engagement, not extraction. Consultation exercises that gather data without visible follow-through erode trust further. Communities need to see their input changes how services are delivered, not just that it’s been recorded.

Recognising diversity within diversity. Ethnically diverse communities are not one group with one set of needs, and South Asian communities themselves span multiple languages, faiths and generations. Local systems need enough depth of understanding to identify which populations are furthest from the five clinical priorities, and why. Rather than treating “ethnic community” as a single PLUS group.