What do health inequalities mean to you?

Timothy Brooker is a member of the REAL (Rights, Empowerment, Action and Lobbying) network which is made up of disabled activists from across Northern Ireland.

What barriers have you faced in accessing health care?

"I have not had problems being seen by a doctor when I need to. If I do have problems understanding things, I ask them to put it in simple terms and the doctors do it. Then I know that the doctor has listened to what I told them. Doctors usually explain things very clearly to me.

The only problem I have had was not with my GP, but with the 'out of hours' doctors. Some doctors do not speak English very well and it can take them longer to understand me."

Have you had any good experiences where doctors have helped or supported you?

"I had an operation a number of years ago, because I was in and out of hospital with stomach problems. The doctor was honest with me; he said 'Look if you come in again we'll have to do an operation to remove part of your bowel'. He also explained that I could be left with a hernia. I thought 'you know what you're doing' and it was best to let him do what he had to. After the operation he came to speak to me and explained what had happened, he even showed me a piece of bowel he had removed."

Is there any thing doctors could do better?

"I don't think there is an awful lot more they could do. They are not robots, they can't get everything right. It would be silly."

Mercy Jeyasingham is Vice Chair of the Afiya Trust (a national charity that works to reduce inequalities in health and social care provision for people from racialised communities).

Inequalities: Can Individual Doctors Make a Difference?

"Inequalities in health are significant amongst Black and minority ethnic communities. Although some variation should be expected, too many inequalities arise from lack of access to health care, inappropriate treatment and late diagnosis. Doctors should be aware that certain conditions are more prevalent in certain ethnic groups and cultural attitudes to health and well being will influence the effectiveness of suggested treatment. But doctors also need to be aware of making assumptions about ethnicity, culture and language.

For Black and minority ethnic communities there are differences between and within them. Therefore communication and understanding has to be a key ability for doctors. It always surprises me when talking to doctors and community members alike when doctors make the wrong assumptions based on ethnicity or culture. I ask myself "Why didn't they just ask the patient?" When I meet community members later, even if English is not their first language, they are more than able to describe what their needs and priorities are.

Good medical practice engages patients. Engaged patients are more likely to point out why a suggested form of treatment would not suit them - instead of going home and not following it. The culture and ethnicity of the doctor does not always make a difference either. Understanding your own beliefs and attitudes has to be a starting point for any doctor. We are all influenced by our culture, ethnicity, experience and training - doctors and patients alike."

Dr Glyn Jones is the Chair of the Faculty of Learning Disability, Royal College of Psychiatrists in Wales.

What barriers do people with learning disability face in accessing health care?

"The presentation of health problems in people with a learning disability can be extremely complex and there is a danger that clinicians may assume that a change in someone's presentation is just a manifestation of their underlying learning disability. There are also significant communication barriers as a result of intellectual and sensory deficits. People with more severe learning disability often require considerable assistance with the recognition and expression of their symptoms, whilst those with milder degrees of intellectual impairment may appear competent whilst actually struggling to understand what's going on in the consultation.

The other huge barrier occurs when patients present with challenging behaviours. This is often an expression of fear, pain or even delirium and it can be hard for doctors to look beyond the patient's agitation to identify potential physical, psychological and environmental causes."

Have you any good experiences where doctors have helped or supported people with a learning disability?

"I can think of a few doctors who stand out. The key features are a willingness to treat the patient as an individual whatever their level of intellectual capacity and to work in a collaborative fashion with families, carers and professionals from other services. Careful preparation and planning really pays dividends."

Is there anything doctors could do better?

"I think there is now an acknowledgement that all doctors need to know more about the special health needs of people with a learning disability. It's also essential that they have a good working knowledge of mental capacity legislation and don't make unduly pessimistic clinical decisions based on ill founded assumptions about the individual's quality of life and their value as citizens. A flexible approach and reasonable adjustments are not just a pre-requisite for the establishment of a rewarding and an effective therapeutic relationship; they're also a legal obligation under the Disability Discrimination Act."

Ros Levenson is Chair of the GMC's Standards & Ethics Committee, which is responsible for reviewing Good Medical Practice.

The needs of older people

"Older people are amongst the main users of health services but, as recent reports of sub-standard care show, they do not always get the treatment and care they need. Disrespect, lack of dignity, poorly coordinated care and a feeling that age is a barrier to the best treatment are recurrent themes.

Updating Good Medical Practice is an opportunity to strengthen the hand of doctors in promoting equality for older people. So what can individual doctors do?

First, they must be aware of ageism and challenge it whenever possible. This may be a matter of attitude - being aware that old age is not an illness and that older people are individuals - or it may be about ensuring that older people get their fair share of resources, or that systems are designed to suit them.

Second, doctors must show respect for older patients, their carers and for colleagues who specialise in the care of older people.

Thirdly, doctors must work in partnership with others. This is especially important with older people who have such a wide range of information and support needs. Doctors don't have to know everything but they should get smarter at working collaboratively with people who know things they may not.

But perhaps most importantly, doctors must retain their ability to be shocked and to react as a human being. Then it would be impossible to stand by a bedside and not notice that the call bell has been tied up, or that the water jug left out of reach."