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Background North East England has worse health, lower life expectancy and higher health inequalities than the rest of England. To tackle this, ‘Deep End’ networks of GP surgeries, serving areas of blanket socioeconomic deprivation, were established to improve patient care and reduce inequality. However, National Health Service (NHS) ambulance service activity in these geographical areas is unknown. This study explores the role of a regional NHS ambulance service operating in the Deep End.Methods The 52 Deep End GP surgeries in North East England were matched to non-Deep End surgeries of similar size and geography. Data for all 999/111 face-to-face ambulance contacts for patients registered with these surgeries from 01/01/2024 – 31/12/2024 inclusive, were extracted for analysis.Results There were 54,739 face-to-face 999/111 ambulance contacts in the Deep End versus 46,070 in the non-Deep End, p<0.01, throughout the study period. Deep End communities were more ethnically diverse and had higher levels of unemployment and disability than non-Deep End communities. Individuals in the Deep End were more likely to use 999 and less likely to use 111 to seek help, p=0.09. Those doing so were younger, p<0.01, and ambulance duration on-scene was longer, p<0.01, despite no difference in severity of illness (NEWS2) p=0.36, or conveyance to hospital rate, compared to non-Deep End individuals. Main paramedic derived clinical impressions for calling 999/111 were chest pain, abdominal pain, seizure and chest infection, with the same frequency in both groups, but with greater prevalence in the Deep End.Conclusion Deep end communities use ambulance services disproportionally to non-Deep End communities, which may be driven by individual characteristics. Further research is required to understand the variation of ambulance service use between these groups, what motivates decisions to access care through ambulance services and what impact this has on ambulance service demand.