Links Project Report:developing the connections between general practices and their communities

2. Summary

The Links Project was a six month project, sponsored by Scottish Government's Self Management Programme, Long Term Conditions Unit and Long Term Conditions Collaborative (LTCC). The project was established in October 2010 to allow General Practice teams, time and practical support to explore the nature of their connections with the communities they serve. Service improvement methodology was used to explore the potential for primary care to be a vital connector by ensuring that sources of local support are identified and utilised.

The project provided a chance to develop themes emerging from numerous recent reports and projects and to learn more about social prescribing and reciprocal approaches required to encourage self care and self management of long term conditions. (Social prescribing is also known as community referral and signposting and is a mechanism for linking patients with non-medical sources of support within the community).

Recognising individual and local assets and taking advantage of all possible sources of support is particularly important in areas of high deprivation, where people are likely to be less empowered, have complex needs, poorer understanding, lower levels of literacy and are less willing to access support unless it is close by.

People's needs often span several service silos and just as care needs coordination, so does local support. However local directories may not be useful as information produced by libraries, Community Health Partnerships, general practice, voluntary and community groups is often siloed, scattered, transient, not updated and hard to access.¹ Most communities have a network of hubs which connect people and offer useful support, such as libraries, churches, schools, voluntary groups and community associations. However many are not well known, may be unconnected, under used, poorly understood and may struggle to maintain their resource because of short term funding. During the course of the project, teams gathered data, case studies and met to explore aspects of linking with communities which influence signposting to non medical resources.

Summary of results (Glasgow and Fife are reported separately)

Glasgow

• The total number of patients with potential to participate was 23,906 (this is combined list size of the 6 practices)
• Information was gathered from 3,704 consultations
• an average of 18% of patients seen were identified by practitioners as having a need for support
• 50% of the identified need was for mental health or addiction services
• of those patients with an identified need, 75% were signposted to a resource
• 57% of patients signposted expressed an intention to accept the opportunity
• of patients referred during January and February who were followed up by practices in February and March, 60% had contacted the community resource
• 70% of those who made initial contact were still using the resource 4 - 6 weeks after signposting
• Some patients were asked to rate the usefulness of the services on scale of 1 - 5 (1 = not useful, 5 = very useful). Of 35 who answered, 18 (51%) rated the service as useful (4 or 5) and 7 (20%) did not find it useful (1).

Between December and March:

• staff who knew enough about community resources to inform patients increased from 24.5% - 65%
• staff confidence to inform patients and recommend community resources increased from 43% to 81%
• staff who considered their practice had good links with community increased from 22% to 48%
• practices identified community resources and created or improved directories of community services.

Fife

• Potential pool of 34,421 patients from 4 practices was used to gather information
• Percentage of consultations identified by practitioners as having a need for support varied (23%, 23%, 21%, and 5%)

Between January and July 2011:

• staff who knew enough about community resources to inform patients increased from 27% - 65%
• staff confidence to inform patients and recommend community resources increased from 39% to 74%
• staff who considered their practice had good links with community increased from 30% to 61%
• practices identified community resources and created or improved directories of community services.

Key observations about linking with community resources:

• a significant number of people living in deprived areas in Glasgow were willing to accept a recommendation from a GP to attend a community resource
• a significant number of patients in Glasgow who accepted the recommendation were still attending 4 - 6 weeks later
• personalised, relationship based approaches are important in connecting services
• it is essential to form good relationships so that trust and common purpose is strengthened, to encourage sharing of care and to disperse responsibility
• access to up to date local information to support community connections is essential
• online access to local information is important
• links which are specific to local context appear to have high value
• experiential learning and making connections is a more powerful tool for understanding and generating action than reading pamphlets
• consultation time is a vital consideration in making effective use of the relationships practices have with patients
• social prescribing was an unfamiliar concept to some members of staff, but there were accounts of significant change in perspective
• staff were interested in signposting to local resources if they had opportunity to become familiar with them.

Key factors in meeting project objectives:

• the project was set up quickly with little bureaucracy, local and national relationships and networks were key to successful organisation
• securing a GP with strong leadership skills who engaged with local practices
• engagement of practice staff who were willing to invest their time and ideas
• Scottish Government budget to allow staff time out of practice to use service improvement tools, make connections in community, reflect on findings
• provision of project management, data analysis and report writing

"Network citizens: power and responsibility at work" describes how new communication networks are "facilitating new relationships and connections between people that circumnavigate old hierarchies" and how "structured organisations must now negotiate new relationships with increasingly empowered individuals." ²

The Links Project found that working with people you know is important. Cultivating local connections and community networks presents an important way to increase opportunities for improving quality of health and wellbeing; however a cultural shift may be needed to encourage joint working. Adopting an organised approach to linking resources may have significant mutual benefits for citizens, primary care teams and providers of support. An emerging vision for improving links in communities is personalised, relationship based supported by robust technology.