Putting advice where people need it most
Integrated advice saves GP time and improves patient health and wellbeing
You might not know that Citizens Advice has delivered advice in GPs’ surgeries for decades. It means we’re where people need our help most — and many of our GP partners recognise support with practical issues like debt and housing can be essential to patients’ wellbeing.
These problems can make stress and anxiety worse — and can affect how someone manages their physical health, something we found through our national impact research.
Last week we launched new research in partnership with the Royal College of GPs (RCGP). We surveyed over 900 GPs across England and Wales — looking at the impact of advice in these settings, and how effective it is.
We also held an roundtable with the RCGP — and these are the 3 things we found out.
1. We can, and should, tackle problems at the root.
We found 19% of consultation time is spent dealing with non-clinical issues — like debt, housing, benefits or relationship problems. And 75% of GPs told us advice interventions had a positive effect on their patient’s health and wellbeing.
Professor Dr Helen Stokes Lampard, Chair of RCGP, explains why social interventions like advice are key in GP settings.
“Advice is an effective and essential social intervention,” she says. “It’s a bit like Maslow’s hierarchy of need. Citizens Advice tackles the issues at the bottom of the pyramid. Without them, patients can’t build upwards and stay well.”
2. It’s important to know what good looks like.
Social prescribing is a way for GPs, nurses and other health care professionals to refer patients with emotional, social or practical needs to a range of local non-clinical services, like social groups, physical activities or advice.
In many areas, we’re working with partners to design and build local schemes. But what does a good service actually look like? And how do funders decide where best to invest resources?
Liverpool Clinical Commissioning Group (CCG) and Derbyshire and Districts Citizens Advice joined the roundtable to explain more about their local service model and what worked well.
The Healthy Advice Service in Derbyshire recently helped elderly couple, Brian and Kathleen. They were referred to the Healthy Advice service when Kathleen, also Brian’s main carer, was diagnosed with Alzheimer’s. An adviser visited them at home, and helped them manage their debts and clear their arrears. They also helped them switch to cheaper energy tariffs, and secured them an additional £250 a week in benefis.
Stories like this tell us what a difference advice makes to patients’ lives. But for commissioners deciding to invest in a service, good data is necessary to build a business case.
3. Data builds a true picture of people’s health.
Liverpool CCG invested in a city-wide “Advice on Prescription” service in 2015 after a two year pilot.
In 2017 the service reduced household debt in Liverpool by £2.6 million — and secured an additional £6.7 million of income for vulnerable patients by helping them access benefit entitlements.
Dr Janet Bliss, Director of Healthy Liverpool Community Programme at Liverpool CCG, explains why they needed to understand and help address the socio-economic factors patients’ were facing.
“We realised that if we didn’t help patients with practical problems, we would not improve their health or tackle unsustainable demand for health services. The Advice on Prescription service has improved patient wellbeing and reduced pressure on GP time.”
Our research chimes with what Liverpool are seeing on the ground. They’re now working on a project to build a data model which compares and contrasts practical problems and clinical trends. The CCG also plans to expand the Advice on Prescription service to encompass wider social prescribing services such like social clubs and activities.
50% of patients in Liverpool hadn’t used an advice service before. “This made us realise that advice in health settings is key,” says Caryn Matthews, Assistant Chief Executive of Liverpool Citizens Advice. “Demand for our high face-to-face services remains high but we realised we were reaching a cohort of vulnerable clients that need our help”.
Making advice available where people already are, makes it easier to help vulnerable people — and can contribute to a model of health and care that puts patient need at the very centre.
Next steps
Blending practical experience with good evidence, the roundtable brought together representatives from health, social care, local government and the voluntary sector to debate the next step for social models of health and care.
There was consensus that social interventions like advice in primary care — whether stand alone or part of a Social Prescribing service — are a perfect vehicle to put patient need at the very centre.
There are clear signals that the long-term NHS Plan will focus more on prevention and integrated working, we very much hope this is the turning point that we see social issues addressed with parity in health settings in England and Wales.
