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Lower stress, better sleeping More effective use of medication Smoking cessation

Health gains from welfare advice. Lower stress, better sleeping More effective use of medication Smoking cessation Improved diet & physical activity Better relationships Housing stability Reduce GP time spent dealing with benefits Fewer repeat appointments & prescriptions

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Lower stress, better sleeping More effective use of medication Smoking cessation

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  1. Health gains from welfare advice • Lower stress, better sleeping • More effective use of medication • Smoking cessation • Improved diet & physical activity • Better relationships • Housing stability • Reduce GP time spent dealing with benefits • Fewer repeat appointments & prescriptions • Advice & health sectors working closely and strategically can help reduce health inequalities

  2. GP & Primary Care workforce Specialist Link Workers Community Link Workers (Socioeconomic focus) (Health & wellbeing focus) Link Worker roles - specialist & community Midwives & Health Visitors Community Organisations Welfare Rights Advisors Scottish Social Security Outreach Team

  3. Background Methods Money advice outcomes Views on project Discussion GCPH evaluation study

  4. 25% claim out-of-work benefits 26% report limiting disability Healthcare staff refer to welfare advice services in 7 health centres 2015-17: advice worker in 2 GP practices Significant number - disability-related benefits; no past advice service contact 2017: embed 3 advice workers in 9 GP practices. Half day advice session, per practice, per week Practices serve 40,000 people - caseloads range from 3,000 to 6,500 Northeast Glasgow profile

  5. Methods Data collected between April 2017 & March 2018

  6. Advice referrals by staff group 665 referrals = 100%

  7. Advice referrals across 9 GP practices GP practice

  8. Money advice referrals, uptake & outcomes (68.9%)

  9. Who is accessing advice? • Majority: below poverty measure for single person (BHC) • 65% (n=422) - annual household income > £10,000 • 19% (n=123) - annual household income > £6,000 • Single women, older, unfit for work, living in social housing • 1 in 5 had children • Two thirds had no contact with advice services in the past year*

  10. Financial gains & managed debts (£)

  11. Individual gains & debts (£ annual)

  12. Accessing other support • 124 out of 451 accessed other services (27.5%) • 166 reasons

  13. Views on project benefits Practice staff • People value appointments • Not paying travel costs • Positive impacts on mental health & financial gains • Some staff reported easing workload Advice staff • Practice as a trusted hub • Reduced stigma • Promoted uptake • Encouraged more openness about money worries

  14. Advice staff access to medical records • Advice staff had access to medical records, after consent – to prepare welfare applications, reports & letters for benefits reviews/appeals. • Three categories of access to medical records identified: • Full access to individuals’ records but ‘read-only’ • Intermediate access to basic information & summaries • Basic access via staff (face to face; staff printing summaries) • Differing views on what access meant between advice & practice staff & practices

  15. Reported benefits and concerns Benefits • Clarify diagnosis, medication, treatment when preparing advice cases • Increase better understanding of wider social situations • Offer more effective advice e.g. avoid stressful benefit appeals • Reduce need to ask GP for further clarification Concerns • Re-emerging anxieties led to some practices reducing access • Need for clearer position across all practices - governance, confidentiality, non-NHS employees, new data protection

  16. Views on future direction • All practice staff make referrals & directly book advice appointments • Provide practices with regular feedback on advice outcomes • Allocate advice sessions to recognise practice sizes (3,000 - 6,500) • Take advantage of the practice as a “trusted hub” • Maximise opportunities - GPs engaging with child poverty - Practice nurses undertaking chronic disease management

  17. Some discussion points

  18. Comparing advice referrals over 12 months

  19. Implications for all Link Workers • Need to tackle important money worries & high household debt levels to address other health & wellbeing priorities • Strong links between debts & mental health, addictions & suicide - disproportionally impacting Deep End GP practices • Social housing: £120,000 gains, rent & council tax arrears were important debts (Universal Credit) • 1 in 4 accessed other support: housing, homeless, mental health & fuel poverty • How can all Link Workers ensure timely access to support e.g. housing, welfare advice, mental health?

  20. Thank you James Egan Glasgow Centre for Population Health james.egan@glasgow.ac.uk www.gcph.co.uk

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