Redesigning council advice services in Dundee

1. Redesigning council advice services in Dundee GP Surgery Co-location model Keith Grubb, Welfare Rights Team, Council Advice Services

2. Key elements of the Dundee Model • Co-located 1 day per week within • Taybank surgery from January 2015 • Lochee Surgery from June 2015 • Family Medical Group from April 2016 • Whitfield Surgery from November 2016 (Brooksbank Centre and Services) • Erskine Practice from January 2018 • Mill Practice from February 2018 • Maryfield Practice from April 2018 • Dedicated named welfare rights officer in each practice • Access to the practice bookings systems • Access to client medical evidence with express client permission. • Confidential interviewing facilities for each session • Aim is to blend in and become part of the practice team. • Direct links into Macmillan Service, Fuel Poverty Service (DEEAP), home visiting service, budgeting and employability services.

4. Links to current work This initiative links squarely with 3 of the Health and Social Care Partnership’s eight strategic priorities and shifts • Health inequalities • Shifting resources to invest in health inequalities • Early intervention/Prevention • Investing in or redirecting existing resources to scale up well evidenced, early intervention and prevention approaches • Models of support/Pathways of Care • Although a specialist service, this is a remodelling of an existing services designed to improve capacity and access to advice and financial referral paths within primary care • Fairness commission recommendations • Reduction of stigma for patients accessing advice via their GP surgery • Easier access to benefits advice and support

5. Outputs, results and outcomes to date • Over £2.7 million in financial gains for patients so far and rising • Embedded within 7 practices • Earlier intervention before things go wrong for patients • Better outcomes for patients’ benefit claims/appeals • Takes burden of socioeconomic concerns away from health professionals and helps to alleviate primary care workloads. • Increasing use of the service by health professionals in the practices. • Between 70% of appointments kept with advisers • 698 separate appointments made within the practices • Faster response times from DWP around ESA and PIP claims. • Social Return on Investment report stated that there was £38 in social and economic benefits generated for patients, advisers, medical staff and funders for every £1 spent • COSLA award winning project (November 2017)

6. Stakeholder quotes • "[Welfare Rights Officer] has permission to go into my records without disturbing the doctor. It's not taking up a valuable appointment that somebody else could take up." (Client) • "It's taken the pressure off the GP. Welfare rights has taken off. The patients are interested. There's no negative issues, not one complaint." (GP Practice Manager) • “Lochee has one of the most deprived practice populations in Tayside and Scotland.  There is a disproportionately high level of mental health problems with low literacy levels.  Many patients are categorised as vulnerable children and adults and single parents.  The list includes many children in full time education who look after parents or other relatives.  Accessing help with claims for appropriate benefits and empowering patients who are otherwise disenfranchised by illiteracy, social phobia, panic, anxiety, depression and addiction is a valuable and time saving resource for practices such as ours.  Not only does this help patients identify medical problems which attract appropriate benefits, it helps them live less wretched lives, and also helps GPs in formulating a more effective management plan for their problem which is consequently less likely to be scuppered by financial concerns.  I would like to develop better communication with our welfare rights workers to engender a more coordinated MDT management plan.” (Dr Salahuddin Malik, Lochee Health Centre)

7. Financial Gains • Taybank gains for clients between 1st April 2016 and 30th November 2017 totalled £ 780,916.49 • Lochee gains for clients between 1st April 2016 and 30th November 2017 totalled £ 412,035.84 • Wallacetown gains for clients between 1st April 2016 and 30th November 2017 totalled £ 534,008.09 • Douglas gains for clients between 1st September 2016 and 30th November 2017 totalled £ 160,533.29 • Whitfield The Crescent gains for clients between 1st November 2016 and 30th November 2017 totalled £ 146,006.70 • Gains for the project between April 1st 2016 and 30th November 2017 totalled £ 2,033,500.41. • The project’s cumulative total gains for clients since between 1st January 2015 and 30th November totalled £2,719,479.17.

8. Case Study • Adviser helped a 35 year old man with both physical and mental health difficulties. • He is a patient at a GP surgery where we have an experienced Welfare Rights Adviser. • He was in receipt of Disability Living Allowance (DLA) and was invited to claim Personal Independence Payment (PIP). • He was made aware of our service in March 2017 and attended for assistance with his PIP claim. • These forms consist of 14 detailed questions on how a person’s disabilities affect their day to day life as well as their mobility.

9. Case Study Outcome • Our client/patient faced issues throughout the claim process, however, with the support of the Welfare Rights Adviser in his surgery, he was able to access other services and all matters were resolved. • He reports that he felt more at ease and less stigmatised with being in an environment he knew. • He received an award of PIP at the enhanced rate of both components. • He states he finds it difficult to explain his conditions and feels he received this level of award due to the extraction of medical evidence. • He has advised that he would have found the process much more stressful had he had to access services in the city centre.