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

6. Findings - Glasgow

6.1.1 Practice Team Questionnaire

Participating staff completed questionnaires. In the short period from December 2010 to March 2011, staff felt more informed (24% - 65%), more confident (43% - 81%) and their views on whether they had good links had also improved (22% - 48%).

Glasgow
Do you know enough about community resources to inform patients?
	Yes	No	Not Sure
Dec 2010	16 (24%)	33 (49%)	18 (27%)
Mar 2011	31 (65%)	9 (19%)	8 (17%)
Do you have the confidence to inform patients and recommend they use community resources?
	Yes	No	Not Sure
Dec 2010	29 (43%)	22 (33%)	16 (24%)
Mar 2011	39 (81%)	1 (2%)	8 (17%)
Do you think the practice has good links with community resources?
	Yes	No	Not Sure
Dec 2010	15 (22%)	17 (25%)	35 (52%)
Mar 2011	39 (48%)	1 (10%)	8 (42%)

Below is selection of staff answers to 3 questions:

1. What makes it hard to signpost?

• could be seen as intrusive
• feel I might offend
• lack of knowledge about contact details and whether service still operating
• some services have long waiting times or are not available locally
• not sure patients would want discuss local resources at the front desk
• people's poor physical and social health prevents them attending

2. What needs to happen within the practice to make it easier for you as an individual?

• more contact with local services to increase awareness of what they offer
• regular updates from resource providers to inform of changes
• having referral forms on docman
• feedback from services on patient progress
• more time in appointment
• nothing, as I feel as practice we have done all we can
• folder with resources available and up to date contact numbers

3. What needs to happen within the practice to make it easier?

• contact telephone numbers on A4 sheet which can be given to patient
• all information in one booklet to give out
• longer appointment times would give opportunity to explain community services to patients
• faster internet connection

6.2 Baseline survey

Data was collected for a baseline survey in 3,704 consultations in 6 practices. The survey was conducted 3 times: December 2010, January and February 2011. The table shows totals for 3 months.

Practices identified services required for their population:

Mental Health, Addiction, Employment, Benefits, Cardiovascular System Risk, Carers and "Others". "Others" included exercise classes, weight management, smoking cessation, housing, homeless shelter, chid care, victim support, panic, loneliness, domestic abuse, back pain, parenting advice, epilepsy support. It should be noted that in a small number of cases, there was inconsistency in how staff classified services - for example smoking cessation was sometimes recorded as "other" and sometimes as "addiction."

Practice	No of consultations	No of patients identified for support	Percent of all consultations identified for support	No of patients recommended a resource	Percent of patients identified who were recommended a resource	No of patients who expressed intention to use resource	Percent of patients who expressed intention to use resource
A	579	124	21%	113	91%	71	63%
B	584	75	13%	57	76%	46	81%
C	493	49	10%	40	82%	28	70%
D	565	155	27%	86	55%	47	55%
E	450	134	30%	115	86%	28	24%
F	1,033	139	13%	96	69%	67	70%
TOTAL	3,704	676	18%	507	75%	287	57%

The percentage of patients identified for support hardly varied in 3 reporting periods (19%, 18%, 18%), nor did the number recommended to a service (73%, 77%, 75%). In the first two months staff occasionally did not know a suitable resource, however this improved in February.

The reasons for not recommending a service included:

• patient already in contact with a service
• not enough time
• too many issues
• already discussed and not interested

The number of patients who expressed an intention to accept the recommendation varied between the different months, (57%, 62% and 49%). The February figure was lower because one practice had a particularly low acceptance rate. There was considerable variation between practices, with between 10% and 30% of patients being identified for support. Generally those practices with high rates of identifying patients have lower rates of patients accepting the recommendations. This may be due to differing practice populations or to differing assumptions about level of need by practice staff. Overall 8% of consultations led to a patient expressing an intention to use support (ranging from 6% - 12% between the 6 practices).

The chart below shows that 50% of patients were identified as in need of mental health or addiction services.

Types of services identified as needed in baseline survey (Dec, Jan and Feb)

6.3 Longitudinal Survey

During 5 days of recording in January and 3 days in February, 81 and 50 individuals respectively were signposted to community resources. A total of 83 (62%) of these patients were followed up by staff in February and March. Of those, 50 (60%) had made contact with the service. Of the 50 who made contact, 35 (70%) were still using the resource 4 - 6 weeks later.

6.4 Patient Follow Up After Signposting

Practices identified patients to follow-up four weeks after initial consultation. Questionnaires were carried out by practice administration or health practitioners.

February and March 2011
Patient follow up (ie visited practice in January, contacted in February)

	Patients Identified	No. followed up	No. followed up who made contact with service	No. who made contact who are still using service
Total	131	83	50	35
Percentage		63%	60%	70%

Examples of reasons given for not making contact:

• planning to get in touch
• chose to use church first
• previous experience - so don't think it would help
• time
• working in mental health and didn't want to contact services in this area
• feeling better with tabs
• GP contacted on patient's behalf
• patient had to go to hospital with tumour
• feeling unwell (flu) / still thinking about it

Examples of reasons for not attending:

• feel unsure about contacting them as feel uncomfortable with strangers
• ill health prevents attendance
• nerves, anxiety about making the phone call. Aiming to do this at some point
• no phone - homeless
• "didn't feel COPE would be beneficial. Has contacted another service instead"
• "planning to do so"
• "does intend to go but working and caring for mum"

Some patients who were followed up were asked to rate the usefulness of the services on scale of 1 - 5 (1 = not useful, 5 = very useful). Of the 35 who answered, 18 (51%) rated the service as useful (4 or 5) and 7 (20%) did not find it useful (1). In some cases patients were waiting to be seen as some services had long waiting lists.

6.5 Directory of Community Resources

Each practice developed directories of community resources, some available online. These usually contained name of resource, telephone number, contact name, address.

6.6 Case Studies and Practice Developments

The following case study is provided by Dr Nugent and Partners, a practice in a deprived area with a practice population of 5,313. Fifteen members of staff formed five groups to visit community based initiatives to find out what was provided:

Group 1 visited the local women's refuge and identified key resources and were impressed by the quality, ethos and perspective of the women's refuge team.

Group 2 visited the West CAT team for drug or alcohol problems where self referrals are accepted. Staff can be refer to a wide range of agencies, prescribe medicines and arrange home visits.

Group 3 visited a children's rights team in Yoker which visits Drumchapel High School. The team provides a wide range of support to young people such as advice on bullying, drugs and children's panels.

Group 4 visited Momentum which through a link worker system helps people with multiple difficulties by providing range of support. There is a wait of no more than a week for a 1-1 appointment.

Group 5 visited the Donald Dewar Centre and were impressed by the quality of the facilities and the informed, enthusiastic and friendly nature of staff.

The visits were later discussed by staff, the early part of the session was attended by five representatives from local services; COPE (Caring Over People's Emotions), the Library Service, Carr-GOMM, Glasgow West Regeneration Agency and Drumchapel Arts Project. The following is a snapshot of their narrative:

Transitions from school: Those who visited the children's rights project asked whether there might be a gap in assisting young adults to make the transition from school to adulthood and wondered what role the practice could play.

Extending knowledge about communities: There was discussion about the time and capacity required to make necessary connections for the benefit of patients. A GP was to have sufficient knowledge of community resources for a GP to say "I can't help with this, but the library can."

Role of Administration Staff: It was suggested that a training resource was needed to ensure that administration staff had sufficient knowledge to match services to patients.

Discussion between practice and community members: It was noted that there was a great deal of support and that those providing support had, like the surgery, a strong ethic of care. Participants from practice and community organisations agreed it was essential to form strong relationships to build trust and common purpose. Staff from community organisations felt there was an under referral of people from general practice.

Discussion with practice staff only: The team felt there was an opportunity for receptionists to signpost, which was considered different from an information management role. Receptionists spoke of wishing to be able to help patients beyond simply saying "the doctor will call you back". It was suggested that a link worker/librarianship role be developed to provide a point of liaison.

Another suggestion was to establish a volunteer programme for signposting. The visits highlighted the number of patients working in local organisations, also seeking to provide good community care.

One organisation, COPE (Caring Over Peoples' Emotions), which promotes resilience and coping strategies, offered a weekly presence at Dr Nugent and Partners.

Some edited comment from staff:

• I didn't know how agencies received referrals … I will start using their services now
• the Links Project was valuable for us and for patients who are registered with us
• Visits worked incredibly well - good to get out of the practice, meet people and see clients using the services. Otherwise just a picture portrait from leaflets and visits from project staff, which is not as powerful as actually seeing services in action
• I will spend a half-day with medical students going around community centres picking up leaflets and speaking to staff
• Would be helpful to have an annual showcase of local resources
• we need a web based directory of services with a snapshot of what's available
• makes you realise that we're all working towards the same goal
• filling out questionnaires was useful, made you realise how many people are presenting with mental health needs or financial worries and we're not the experts
• There's been a clear improvement in my awareness as a GP of the various community resources. For so many years you're aware that new projects start and you're not too sure who they're suitable for and what's available
• there are some great enthusiasts, people who love their area of work and to see not only what the service is but who the patient would meet.. face to face contact has been a great thing
• we've found out about resources even here in the health centre that we didn't know about
• … discovered a lot of team knowledge we haven't tapped into