Proportionate Universalism Management in General Practice (PUMA GP) The challenge: People in vulnerable situations often hit roadblocks when accessing healthcare. Despite efforts to improve healthcare for all, ensuring equitable access to healthcare remains a steep climb. The dominant focus on individual patient care might leave certain groups in precarious situations behind. These inequities not only make existing health problems worse but also impact community well-being and come with associated costs. The solution: A more community-oriented approach recognizes healthcare as a collective concern, channelling resources where they are most essential within the community. The PUMA GP project champions this paradigm shift, advocating for the integration of Proportionate Universalism (PU) in General Practice management . The ‘Marmot Review’ on health inequalities in England argued that: “To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportional to the level of disadvantage”[1]. PU is a public health strategy that counteracts the effects of the inverse care law, which asserts that those in greatest need of health care often have the least access, while conversely, those in lesser need tend to have better access[2]. Health Care interventions may inadvertently worsen existing health disparities by benefiting individuals who are already well-served, while inadequately addressing the  needs of people in vulnerable contexts. PU advocates for targeted interventions that allocate more resources and support to those who are most disadvantaged, all while benefiting the entire population and as such avoiding the creation of new inequities. PU goes beyond being a series of interventions to reach people in vulnerable contexts. It represents a social innovation aimed at transforming HC systems from their current unequal accessibility to a system that allocates additional efforts and resources based on individual needs. The concept of PU has gained significant policy interest. However, there are few practical examples of its implementation, and applying it in HC presents numerous challenges. The unique contribution of this project lies in operationalizing PU in General Practice management. How? THE PUMA GP PROJECT IS PASSIONATELY COMMITTED TO FOSTERING SOCIAL INNOVATION IN PRIMARY CARE BY EMPOWERING CITIZENS, GP’S AND OTHER PRIMARY CARE PROVIDERS AS ACTIVE DRIVERS OF CHANGE, DEEPENING UNDERSTANDING OF THE ROOT CAUSES OF INEQUITIES, MOBILIZING RESOURCES EFFECTIVELY AND ADVOCATING FOR PROPORTIONATE UNIVERSALISM MANAGEMENT IN GENERAL PRACTICE. PUMA GP CONTRIBUTES TO A HEALTHCARE SYSTEM THAT TREATS EVERYONE EQUALLY, IMPROVES OVERALL HEALTH OUTCOMES, AND BENEFITS SOCIETY AS A WHOLE. With the active engagement of stakeholders, including citizens in vulnerable contexts, the project will craft and validate instruments for implementing proportionate universalism in General Practice. The development of these resources will stem from a range of research activities, including deepening the understanding of inequities in access to care by analysing existing data, collecting new data in communities, understanding and mapping the complexity of interacting determinants, identifying points of action, and developing and testing strategies. Four specific objectives underpin the projects main mission of transforming General Practice management by incorporating the concept of "proportionate universalism" to tackle inequities in access to health care and services: Assess inequities in access and uptake of care services, to identify root causes of these inequities at both the demand and supply side and to evaluate the impact on health and well-being for individuals in vulnerable situations. Co-create and co-evaluate strategies to overcome inequities in the use of primary care services. Foster collaboration and knowledge exchange among researchers, patients, community members, care providers, data providers, interest groups, and policymakers across diverse contexts. Visually present and effectively communicate, disseminate and exploit knowledge, project outputs, and other information to stakeholders in the pilot sites and key groups beyond the consortium.   [1] Marmot M. Health equity in England: the Marmot review 10 years on. BMJ. 2020 Feb 24;368:m693. doi: 10.1136/bmj.m693. PMID: 32094110. [2] Francis-Oliviero F, Cambon L, Wittwer J, Marmot M, Alla F. Theoretical and practical challenges of proportionate universalism: a review. Rev Panam Salud Publica. 2020 Oct 15;44:e110. doi: 10.26633/RPSP.2020.110. PMID: 33088291; PMCID: PMC7556407.