Partnership work between primary care and money advice services

Since 2013 the GCPH has been working alongside the General Practitioners (GPs) at the Deep End project which is a group of GPs working in 100 general practices in the most deprived areas of Scotland.

The majority of the Deep End practices are located in Glasgow, which is facing the biggest local authority loss in Scotland as a result of the UK government’s welfare reforms. Against this backdrop, the GCPH, the Deep End project and other partners have been exploring how the links between primary care and money advice services can be improved to mitigate the impact of the welfare reforms in the city.

Between 2014 and 2015, two events brought together partners from primary care, health improvement, universities, money advice services, and Glasgow City Council to look at developing effective responses to the reforms. Learning was captured in two Deep End reports (Report 25 and Report 27) with key outputs including: submission of a funding bid to develop software that would allow GPs to quickly produce reports to support patients’ appeals, which was unsuccessful; a six-month post created within the council to explore the use of medical information in appealing DWP decisions; and, a six-month sabbatical for a medical student to work in a Deep End practice. The sabbatical led to the development of a toolkit that outlined local advice services that patients can access and provided information and resources on the benefits system for GPs.

Building on this work, our study explored in detail how the reforms were affecting GP practices; with a particular focus on how ongoing GP work with advice services could be strengthened. Key findings to emerge included:

  • Evidence from GPs of health and wellbeing effects for patients stemming from the process of benefit reassessment, reduction or sanction.
  • Increased workloads for GPs in providing evidence to support patient appeals of decisions made by the DWP.
  • Anticipation of increased demand for advice services flowing from welfare reforms including the expansion of Universal Credit and Personal Independence Payments.
  • Associated challenges involving the funding and scaling-up of the integrated advice service model within General Practices across the city. 

The report also outlined how GPs could be supported to improve outcomes

  • By developing the provision of advice services in a manner which is non-disruptive to consultations and requires no additional work from GPs.
  • Through recognition of a need for a proactive approach on behalf of advice services to target at-risk groups.
  • Ensuring that requests for benefit appeal letters are specific about the evidence required to increase the likelihood of positive decisions for patients.
  • Providing GPs with salient feedback on attendance at advice services and outcomes, such as any financial gains achieved, to encourage future referrals and help build trust with local advice services. 

Current work

More recently, partners from health and housing have developed and tested approaches to delivering advice from general practice settings. Initially piloted at two GP practices in north east Glasgow, the project now involves a total of nine practices with embedded advice workers. 

An evaluation of the first two practices demonstrated high levels of engagement and positive social and economic outcomes for people engaging with the service. 

The recent report, Building Connections: co-locating advice services in GPs and job centres, looks at approaches to delivering advice services in two general practices and two job centres in north east Glasgow. 

Related topic: Healthy communities