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

3. Background

Health care planners worldwide are seeking effective ways to promote health and wellbeing, prevent poor health and improve management of long term conditions. Existing models of supporting people to live well are not sustainable and bold approaches are required to ensure the NHS in Scotland continues to meet the needs of the future, particularly for those who are poorest. There may be potential for general practice to enhance integration of health and social care and traditional and non medical support by making stronger connections with the communities they serve. Primary and secondary prevention of poor health and supported self management will be key to improving life expectancy in deprived areas.

Scotland is in an internationally important position to demonstrate improvement in quality of healthcare and has set out an ambitious vision for achieving this in the Health Quality Strategy for NHSScotland (2010).

An important factor in realising the vision of the Quality Strategy lies in our system of universal coverage and expertise of providing care in deprived areas. The GPs at the Deep End report³ makes reference to primary care's unique position in the NHS:

"Routine contacts with patients, accessing general practices with a wide range of problems, provides over 90% coverage of the population. Serial contacts provide continuity, flexibility, coordination, sustainability, long term relationships and trust. No other part of the NHS has these essential intrinsic features. Such features make general practice the natural hub for NHS activity, especially in very deprived areas. The challenge is to link this hub with other professions and services so that patients receive co-ordinated, integrated care, according to their needs."

The role of social prescribing was explored in one of a series of 12 articles produced by the GPs at the Deep End.⁴ The GPs who took part in the Social Prescribing Project thought that it was important to help patients take control of their health and wellbeing and saw this as a core primary care role, centred on their personal relationships with individual patients. The GPs "valued other organisations that can further this goal, and regularly point patients in their direction".

Primary care teams are central to developments designed to increase social capital and members of the team, such as receptionists who often live locally and community nurses already have valuable local knowledge. This is particularly important as the rising number of people with long term conditions are higher users of the health and social care services and account for a majority of GP appointments.⁵

Support to live well may be accessed through signposting to local opportunities for arts and creativity, physical activity, learning new skills, volunteering, mutual aid, befriending and self-help, as well as support with issues related to employment, benefits, housing, debt, legal advice, or parenting.

This community aspect of supporting self management was explored in the Scottish Government ALISS project⁶ (Access to Local Information to Support Self Management). Adult learners, who were attending an adult literacy group, tracked their journey of seeking support to live well with their long term condition(s) in their local community. The findings were that although support was there, people usually missed it; it was hard to access information about local resources. The ALISS project echoed numerous reports which refer to the negative impact of poor health literacy and need for robust advocacy systems.

The Links Project was an opportunity to examine accessing local support from another angle, the perspective of primary care staff, to find out what they knew about community resources and how prepared they were, both culturally and in practical terms, to signpost people to local groups and organisations.

The project used service improvement methodology to diagnose problems, identify opportunities for change, plan and test changes and measure improvement. One of these methods was the Plan Do Study Act, a cycle of change which encourages growth of knowledge through making changes and then reflecting on the consequences on those changes.