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

7. Findings - Fife

Four Fife practices joined the project at a later stage, in December 2010. Practices used the same tools, with some additions, to ensure comparable information. Three or four PDSA's per month were completed which reviewed service improvement aspects of the project.

7.1 Practice Team Questionnaire

Staff who knew enough about community resources to inform patients increased from 27% - 65% and staff confidence to inform patients and recommend community resources increased from 39% to 74%.

7.2 Baseline Survey

The range of social issues identified in Fife was broader than identified in Glasgow and included social isolation, alcohol problems (both patient and family members), abuse, obesity, inactivity, mental health problems, addictions, employment issues and financial problems. Participating clinicians reviewed 50 consecutive consultations and recorded additional support needs in January 2011. The percentage of consultations reporting a need for a community resource varied (individual practice results: 23%, 23%, 21% and 5%). Example of needs identified in one practice:

55 people had a total of 91 support needs (some people had more than one issue):

22% social isolation, 22% CVS Risk, 20% mental health, 20% obesity, 16% benefits/ employment problems, 14% addictions and 9% relationship problems.

7.3 Longitudinal Survey

Five clinicians from each practice completed this survey at the beginning of the project and three months later (January and April 2011.) Clinicians were asked to record (for one week) details from consultations in which they "signposted" a patient to a community resource or a non-clinical support service, clinicians also asked patients for consent to follow-up.

Numbers of recorded consultations in which patients were sign-posted, was much lower than in the baseline survey, only 3-9 per practice. The following reasons were given:

• the "issue" may be identified but may not be appropriate to sign-post to resources on that occasion
• clinician may not have enough knowledge of local services to sign-post
• too many other issues needing to be considered during consultations
• need to obtain patient consent for follow-up which increased the complexity of the consultation
• lack of time during the consultation hindered sign-posting

7.4 Patient Follow-up after Sign-posting

This process was time consuming. The original plan was for non-clinical staff to follow up patients after sign-posting, however it was often more appropriate for clinicians to do this. Of those patients contacted some had "not yet" accessed the website or community resource. Patients appreciated the information and a few patients went on to access a service as a result of the follow up contact.

7.5 Directory of Community Resources

During the early part of the project the majority of staff reported that they were unable to advise patients about community resources due to lack of information. In order to support staff practices developed a directory of local community resources. Two practices recorded details for 60 different community resources. It was hoped that the information collected could be utilised either by using ALISS or the "Living with my Condition in Fife" website.

7.6 Case Studies and Practice Developments

• one practice connected to a local exercise referral pathway
• arrangements were made for individual staff to visit organisations listed in their directory, to improve practice knowledge and links
• Two practices organised "road-shows" for practice and community staff. This provided the opportunity for organisations such as local library; Cool-to-talk; Circle-of-Comfort; Scottish Slimmer's to present their services, an event which evaluated very highly
• discussions with Citizen's Advice and Rights Fife service resulted in one practice making arrangements for a weekly session to be held in the practice
• a focus group was formed to discuss improving voluntary help

Some edited comment from staff:

Advantages:

• database of community resources will benefit me as it's time consuming finding information
• know much more now about the available community resources, I have referred patients to a variety of things e.g. "cool 2 talk", Zumba, mood café
• Protected Learning Road-show was exceptionally helpful in highlighting available resources
• Now have the CAB coming in regularly, very helpful x 4 comments
• I know considerably more than I did in January
• We are able to inform people that there are 82 community projects available ranging from "Bums off Seats" to Alcoholics Anonymous

Disadvantages of the project:

• frustrations around getting the whole practice team involved
• it was time-consuming and difficult to fit in with everything else
• there was some repetition
• time needed to fill in forms
• Need an easy access point for resources? Touch screen facility in for patients
• need feedback from users about resource before I feel comfortable signposting

Reflections from Fife

• patients appreciated the holistic approach, however there was concern about extended consultation times
• development of practice directories was a useful product of the project
• members of staff were enthusiastic about finding out about local resources
• Contacting local resources, establishing an accurate database and organising the project was very time consuming. Ways of sharing knowledge with staff not involved in data collection would need to be established
• road-shows held by two practices improved the teams' knowledge of local services and strengthened links between practices and services
• staff felt hopeful that patient care would improve as they were better able to offer or suggest local community resources