My last two blogs have looked at the relationship between welfare rights advice and general practice. Some respondents have drawn my attention to two recent reports:
- The Deep End Advice Worker Project – embedding an advice worker in general practice settings produced by the Glasgow Centre for Population Health. The Deep End Group are one of the main voices for GPs serving disadvantaged communities.
- Advice in practice – Understanding the effects of integrating advice in primary care settings produced by Citizens Advice and the Royal College of General Practice
If you only have limited time read the Deep End one – it’s more thorough and better; this is why….
It’s positive that Citizens Advice and the RCGP have produced a joint report, hopefully there is more to come – but its conclusions and evidence are already well rehearsed – although it is good to have this information in one place.
Unfortunately, “Advice in Practice” does not mention inequality (or deprivation or disadvantage) at all!
Lets face it this is why access to welfare rights is so important. I sometimes think that national agencies are reluctant to acknowledge that inequalities exists and that addressing these requires what Michael Marmot calls proportionate universalism
As I mentioned in an earlier blog Citizens Advice Sheffield serves people from across the city but we are far more likely to be needed and used by people in poorer communities – we see 20% of households each year in the poorest wards in Sheffield compared to 3% in the wealthiest!
This is an inequality issue – the pressures faced by people on low income plays out in general practice too, there is no recognition of this at all in the report.
As the Deep End report says:
“people who require the greatest medical support experience the greatest difficulty accessing it… this also applies to social and economic advice services where the most vulnerable experience more difficulty accessing services than their more affluent counterparts”
I think that the data in the Citizens Advice/RCGP report must be treated with caution because by giving a country average it masks what a difference in the balance of demand between practices serving wealthier communities and those serving poorer ones. It concludes that non-clinical issues take up 20% of GP time. Anecdotally I am told by Deep End GPs that this proportion is higher in practices serving poorer communities.
“Before this service was introduced (welfare rights), 50% of my workload was taken up by the socioeconomic problems of patients” – GP quoted in SROI and Co-location report.
Contrast this with the Deep End report which explicitly focusses on the relationship between poverty, welfare rights and primary care.
The Deep End service model is an embedded model – more integrated than the “co-located” one described in the Citizens Advice/RCGP report not only are advice workers on site but they have (through informed consent) access to medical records held by the General Practice. They are not only providing a service of direct benefit to patients but also have some evidence that they are reducing GP workloads.
“It is contributing to reduced time spent by GPs on paperwork relating to benefits, it lets us get on with the job we are trained to do”
- we need an explicit focus on inequalities – General Practitioners serving disadvantaged communities are under tremendous pressure this is where the need is greatest, its about time this was recognised by national bodies such as RCGP and Citizens Advice
- Tactically focussing on the most deprived areas makes sense – it gives a clear message to commissioners that a more targeted approach is appropriate and achievable.
- Following on from this I think that there is a growing case to be made for a different service model in disadvantaged communities for general practice which should include welfare rights provision – this will require a change in behaviour by GPs and Welfare rights agencies – the Deep End report is a useful example – particularly with regard to data sharing.
- national bodies need to set out the arguments for how these services should be funded. To date there has been a reliance on individual commissioning champions leading to models that include public health budgets, CCGs and sometimes practices themselves. This is not systematic or sustainable.
What do you think?
With thanks to Dan Hopewell from Bromley Bow and Oonagh Robinson from the University of Glasgow for her advice.