Improving General Practice Sustainability Group: 2019 Report

Annex A Case Study: 1 - Community Link Workers (CLW)

The Scottish Government has made a commitment to deliver 250 Community Link Workers^[23] over the life of the Parliament, building on the existing 53 SG-funded post holders who are already working in areas of socio-economic deprivation. Early adopter sites include Dundee, Glasgow, North Ayrshire, Inverclyde and Edinburgh. CLWs will be provided to patients in GP practices or clusters of GP practices by health boards under the new GP contract. Their roles will be designed and planned by Health and Social Care Partnerships, based on assessment of local need, collaborating with local GPs, patients and the third sector, the latter being a valued part of the mix.

Impact on GP Sustainability
Evidence provided by one study where analysis of data for 148 patients over a 6 month period showed a reduction of 0.63 appointments per patient (93 less appointments), and reduction in the number of prescriptions issued for anti-depressants (22%) and hypnotic/anxiolytics (42%). Early adopters are continuing to test and refine the evaluation framework being developed by Health Scotland.^[24]

One GP working closely with their WRO^[25] advised that in one case, a 35 year old homeless patient with a history of mental health and drug problems, was found fit to work by the DWP, despite presenting with a number of chronic co-morbidities requiring multiple prescriptions. The patient felt unable to comply and expressed feelings of hopelessness and suicide. Within 2 days of meeting with the WRO, a mandatory reconsideration letter was submitted, along with supplementary medical evidence detailing his physical and mental health problems. The hospital letters were printed from the medical records by the WRO. The patients mental health improved significantly and he no longer required crisis or emergency services.^[26]

Another prominent GP has opined that "The GP workforce is in crisis at the current time, and the 10-minute appointment is no longer fit for purpose for patients with the most complex health and social care needs. Having access to a CLW allows me to practice more "realistic medicine"'^[27]

Further anecdotal evidence suggests that "Over the last 25 years a body of evidence has emerged illustrating the effectiveness of collaborative working between the advice sector and general practice.The outcomes for patients include income maximisation, being re-housed, repeal of sanctions, increased literacy skills, new social networks, increased confidence and self-esteem, and better self-management. The outcomes for GP's are that they feel more productive, able to provide an alternative to prescribing, and see a reduction in patient need for clinical intervention."^[28]

Contact: Kate Burton, Public Health Practitioner, ScotPHN Kate.Burton@nhslothian.scot.nhs.uk