2. Health gains from welfare advice
Lower stress, better sleeping
More effective use of medication
Smoking cessation
Improved diet & physical activity
Better relationships
Housing stability
Reduce GP time spent dealing with benefits
Fewer repeat appointments & prescriptions
Advice & health sectors working closely and strategically can help reduce health inequalities

3. Link Worker roles - specialist & community
GP & Primary Care workforce Specialist Link Workers Community Link Workers (Socioeconomic focus) (Health & wellbeing focus)
Midwives
& Health Visitors
Welfare Rights Advisors
Scottish Social Security Outreach Team
Community Organisations

4. GCPH evaluation study Background Methods Money advice outcomes
Views on project
Discussion

5. Northeast Glasgow profile
25% claim out-of-work benefits
26% report limiting disability
Healthcare staff refer to welfare advice services in 7 health centres
: advice worker in 2 GP practices
Significant number - disability-related benefits; no past advice service contact
2017: embed 3 advice workers in 9 GP practices.
Half day advice session, per practice, per week
Practices serve 40,000 people - caseloads range from 3,000 to 6,500
* £78k funding includes in-kind support for project coordination and evaluation

6. Data collected between April 2017 & March 2018
Methods
Data collected between April 2017 & March 2018
Individual interviews with Senior Health Improvement Lead & 3 advice staff working across 9 GP practices.
Eight out of the 9 GP practices took part in group discussions. There were 2-7 practice staff per group discussion.

7. Advice referrals by staff group
Perhaps unsurprising as the project wanted to test if GPs would engage with the project.

8. Advice referrals across 9 GP practices
Practices 1 & 2 both had an embedded advice worker from Dec onwards.
Both started 2-3 months ahead of the majority of other participating practices.
GP practice

9. Money advice referrals, uptake & outcomes
(68.9%)

10. Who is accessing advice?
Majority: below poverty measure for single person (BHC)
65% (n=422) - annual household income > £10,000
19% (n=123) - annual household income > £6,000
Single women, older, unfit for work, living in social housing
1 in 5 had children
Two thirds had no contact with advice services in the past year*
Question about past contact with advice services introduced Sept asked.

11. Financial gains & managed debts (£)
Rent and council tax arrears were also significant aspects of household debts.

12. Individual gains & debts (£ annual)

13. Accessing other support
124 out of 451 accessed other services (27.5%)
166 reasons
Other includes: money advice, welfare rights, financial capability, employability, health and wellbeing, employment.
New data showed hat d

14. Views on project benefits
Practice staff
People value appointments
Not paying travel costs
Positive impacts on mental health & financial gains
Some staff reported easing workload
Advice staff
Practice as a trusted hub
Reduced stigma
Promoted uptake
Encouraged more openness about money worries
Trusted hub important, as many reported no past contact with advice services.

15. Advice staff access to medical records
Advice staff had access to medical records, after consent – to prepare welfare applications, reports & letters for benefits reviews/appeals.
Three categories of access to medical records identified:
Full access to individuals’ records but ‘read-only’
Intermediate access to basic information & summaries
Basic access via staff (face to face; staff printing summaries)
Differing views on what access meant between advice & practice staff & practices
EMIS, Docman & Vision are the 3 most commonly used record systems in primary care - allow professionals to record, share and use vital information.

16. Reported benefits and concerns
Clarify diagnosis, medication, treatment when preparing advice cases
Increase better understanding of wider social situations
Offer more effective advice e.g. avoid stressful benefit appeals
Reduce need to ask GP for further clarification
Concerns
Re-emerging anxieties led to some practices reducing access
Need for clearer position across all practices
- governance, confidentiality, non-NHS employees, new data protection
General Data Protection Regulation (GDPR) aims to give control to individuals over their personal data and to simplify regulation within the European Union.

17. Views on future direction
All practice staff make referrals & directly book advice appointments
Provide practices with regular feedback on advice outcomes
Allocate advice sessions to recognise practice sizes (3, ,500)
Take advantage of the practice as a “trusted hub”
Maximise opportunities
- GPs engaging with child poverty
- Practice nurses undertaking chronic disease management
E.g. Glasgow has 146 practice nurses (WTE). 2015/ ,336 registered cases of chronic diseases* with 58,244  reviews undertaken - majority by practice nurses.
Opportunity to increase uptake of unclaimed disability-related benefits?

18. Some discussion points

19. Comparing advice referrals over 12 months
This is perhaps unsurprising as tackling child poverty remains a priority since Health Visitors - established referral pathway following 2010 launch of Healthier, Wealthier Children project, which was subsumed into health centre model.
Between April 2018 and March 2019 there were 837 advice referrals.

20. Implications for all Link Workers
Need to tackle important money worries & high household debt levels to address other health & wellbeing priorities
Strong links between debts & mental health, addictions & suicide - disproportionally impacting Deep End GP practices
Social housing: £120,000 gains, rent & council tax arrears were important debts (Universal Credit)
1 in 4 accessed other support: housing, homeless, mental health & fuel poverty
How can all Link Workers ensure timely access to support e.g. housing, welfare advice, mental health?

21. Thank you James Egan Glasgow Centre for Population Health