The following case study looks at action taken by Glasgow City Health and Social Care Partnership (GCHSCP). They wanted to improve patient access to specialist money advice by embedding a service in Deep End GP practices in North East Glasgow.
Reason action was taken
As noted in our take the right actions page, one of the key ways to reduce health inequalities is by providing quality services with the allocation of resources proportionate to need.
People living in deprived areas of North East Glasgow experience some of the poorest health and social outcomes in the country. Social welfare problems have a significant impact on physical health and mental wellbeing and people can develop multiple problems with damaging health effects.
Busy GP practices
As a result of welfare reform and austerity, already stretched GP practices are facing increasing pressure to deal with patients’ socio-economic problems and the immediate effects of poverty. This is giving them less time to focus on their clinical needs.
GPs estimate that non-clinical issues, primarily related to welfare benefits, housing and debt or financial difficulties, take up almost 20% of their time.
Benefits of embedding advice services within health settings
Embedding advice services within health settings is most effective as it targets the most vulnerable within settings they trust, and where their specific health needs are understood. Typically, financial issues raised by patients in GP practices are more complex than those usually seen via standard welfare rights pathways.
Embedded services are also more accessible for people who have difficulty in attending more centralised services due to
- poor health
- lack of transport
- psychological barriers.
The project started in December 2015 in two GP practices. Another seven were added in the summer of 2017 then a further eight in April 2019 resulting in 17 in total in North East Glasgow across three GP clusters.
A specialist money advisor was embedded in each GP practice for half a day per week. Practice staff made electronic referrals to the advice agency (GEMAP Scotland Ltd) which triaged patients and scheduled appointments.
After getting patient consent, advisors could access medical evidence (if appropriate) to support benefit applications and appeals. Advisors were encouraged to build relationships with practice staff to help generate referrals and to increase their knowledge of financial inclusion issues.
People who helped
Two GP practices in Parkhead Health Centre were the first to successfully test the model (in early 2016) and they were instrumental in advocating the approach with local colleagues.
The North East health improvement team oversaw project implementation, operational delivery and performance.
The leader of the Scottish Deep End Project and the Clinical Director for North East Glasgow, Glasgow Centre for Population Health, Wheatley Group and Building Connections also supported the project.
The project is currently funded by GHSCP and Clyde Gateway.
Impact and lessons learned
The GP contract and Primary Care Improvement Plans set out a vision that GPs will be supported by an appropriate and effective multi-disciplinary team model.
- maximises the contribution of clinical and non clinical staff
- provides person-centred interventions that reflect local population needs.
Embedding specialist money advice services in GP practices serving deprived communities
- would be the preferred setting for most people experiencing money worries
- could reduce GP workload
- could play a significant part in tackling long standing health inequalities.
Cost and savings
It cost approximately £5,800 per annum to embed a money advisor in each GP practice for half a day per week. The cost covered all patient-facing time (appointments) and the completion of case work related to the patients accessing the service.
In 2017/18, the project achieved £1.5 million in financial gains. This meant that about £25 was generated for every £1 invested in the project.
In 2018/19 there were 837 patients referred and 510 of these (65%) engaged and received a service.
This resulted in
- 582 benefits being awarded
- £1,625,138 of financial gains
- £695,095 of debt managed
- £85,832 of council tax negotiated.
People entitled to disability-related benefits achieved the greatest financial gains. This is important as disabled people and their families continue to be among those hardest hit by welfare reform.
Addressing child poverty
The project also showed that GP practice staff have a role to play in mitigating child poverty by routinely asking families about money worries. This could potentially contribute to achieving Scotland’s ambitious child poverty targets.
Reduced GP appointments
Some GPs believe that the service reduces GP appointments for welfare-related concerns, thus saving time.
More productive interventions
Money advisors state that accessing medical evidence empowers them to prepare high quality advice interventions to ensure that vulnerable people do not have to spend unnecessary, and at times stressful, amounts of time in the appeals system. This reduces anxiety levels.
A trusted and stigma free environment
The finding that patients perceive their GP practice as a trusted and stigma free environment where they can be open about discussing money worries is positive. This is given the large number of households struggling on very low incomes who are either unaware of their entitlement to important benefits or feel unable to access advice through other routes or settings.
You can find out more about ways to reduce health inequalities within our reducing health inequalities section.
Find out more about financial inclusion referral pathways within GP practices, including a video with examples from Lothian and Dundee, in our child poverty section.
This case study is based on information provided by Douglas O’Malley from the North East Health Improvement Team within GCHSCP. If you would like to discuss further, you can contact our Health Promoting Health Service (HPHS) team by email at nhs.HealthScotlandfirstname.lastname@example.org.