Equity Over Equality: Post-Brexit Demographic Change, Workforce Pressures, and the Future of Equitable Primary Care in England

General practice (GP) in England faces structural pressures that incremental reform is unlikely to resolve: a contracting GP workforce, a rising burden of multimorbidity, digital transformation that risks widening access inequalities, and a post-Brexit change in the composition of migration.This narrative review, reported with reference to the Scale for the Assessment of Narrative Review Articles (SANRA), asks whether the current model of general practice in England is configured to deliver equitable care over the coming three decades and what structural changes the evidence supports.Published and grey literature from MEDLINE, Embase, the Cochrane Library, Google Scholar, and national policy sources was synthesised thematically.Three cross-cutting themes are examined.First, the post-Brexit shift in migration: by 2021, 16.8% of residents of England and Wales were born outside the UK, and since the end of European Union (EU) free movement, net migration has been driven by non-EU nationals while EU net migration has turned negative, with implications for culturally and linguistically competent care.Second, the distinction between equality and equity, framed by Marmot's principle of proportionate universalism.Third, the transformation required of the GP role within integrated neighbourhood teams.Observational evidence consistently associates personal continuity of care with lower mortality, and cross-national comparisons associate stronger primary care with better population health; workforce and access inequalities along deprivation lines have widened.Prospective evidence that specific reform models work at NHS scale remains limited.We conclude that three interdependent changes are indicated: integration into multidisciplinary neighbourhood teams that protect continuity, contractual reform that weights resources for deprivation, multimorbidity, and language need, and a workforce strategy built as much on retention and cultural safety as on recruitment.We propose measurable indicators for each.The trained generalist, able to hold undifferentiated clinical complexity over time, is likely to remain central to whatever model emerges.