Deep End GP support of Glasgow Community Links Practitioners

GP gives support and evidence from a lived experience perspective of the essential role of Community Links Practitioners.

As one of the partners in a Deep End GP, I have seen first-hand the significant benefit that Community Links Practitioners (CLPs) have to a deep end practice such as ours. I joined this practice two years ago, coming from a practice that didn’t yet have a CLP. I IMMEDIAITELY witnessed the benefits, both to the patients involved and the resources and input made available to them (that a GP couldn’t offer as we are not aware of such resources, or trained to use them), but also the significant reduction in appointment requests from the patients who are working with their CLP. This then benefits the other patients in the practice as they are finding it easier to access GP slots, so everyone benefits. Additionally, this has made a significant impact on reducing GP stress and burnout. Prior to this service, we were floundering in social care and wellbeing issues without the time and resources to fully help the patients. Now that we have this vital service, we don’t know how we can go back to previous times, particularly with the increased work burden and demands that pandemic delays have brought. More particular to our local area, the vast increase in asylum seekers needing practical in-depth support from CLPS is huge and not sustainable for GPs alone. 

I have reviewed and collated some cases of CLP involvement with anonymised patients to show the lifechanging impact of CLPs, and just how important this service is to our practice and community: 

• LH- a single mum in her late 20s, fleeing domestic violence, was helped from Nov 2021 to Jan 2023 with housing, finances, domestic violence support, childcare issues and was supported with advocacy to attend relevant meetings, and is now happily settled safely in her own home with her child. 57 of 59 attendances to the practice were with the CLP, showing how much of her situation affecting health was due to socio-economic stressors. Without the CLP, there would have been significantly more GP appointments seeking our help for these issues.

• EM – a young male asylum seeker with significant physical and mental health issues. CLP worked with him in association and liaising closely with the community mental health team to seek out English lessons, practical support such as clothing, food, assisting with bus pass to increase independence and a GAMH worker to build on this. He is now independently managing his health and welfare as of May 2023. Prior to CLP involvement, all the individual medical specialities were struggling to get this sort of improvement. Prior to CLP we struggled to get him to be compliant with medication or attend vital appointments with GP. He can now do this easily. 

• LH – a woman in late 50s with significant mood chronic pain issues and poor coping, was a very frequent GP attender as wasn’t coping well with day-to-day life. Since starting to work with the CLP there has been a 75% reduction in GP appointments made by the patient as CLP more suitable. She attends the Promising Links group for loneliness and enjoys this, has been helped with housing hospital transport, GAMH and listening ear services.

• LB- an elderly carer of an adult child with learning disabilities, worked with CLP from Feb 2021 to March 2023, who helped her deal with issues such as mood, past abuse, isolation, carer support. She was supported to consider options such as Sandyford trauma counselling, Moira Anderson foundation, Connect helpline, gas meter difficulties sorted on her behalf, WAHP, as well as regular welfare checks which were very important due to feelings of isolation. She also benefitted from the walking group, goal-setting,  digital training and the GGC handy person service. This benefited a lot of the issues for the patient enormously as well as reduced attendance to GP with these issues by 30%.

• JW – a young man experiencing poor mental health and homelessness – 78% of appointments in the last 3 years have appropriately been with CLP to manage these issues and offer welfare check something that we as GPs are unable to do.

• JF- a mother and carer for children with complex health needs has worked with CLP and been successfully receiving support as a result from Glasgow carers, 3D Drumchapel SEN group and peer support, as well as supporting her to have protected time to relax and de-stress through book clubs, chair yoga etc. CLP also was able to set up RADAR key for accessible toilets which helps when out and about with the children. 

• JMC – a woman living alone in her 60s with chronic pain , low mood and poor mental health. She would attend GP over 90 times a year with very little that GP could do regarding these issues and motivation for self-help and social issues was poor. Since CLP became involved there has been a 44% reduction in GP appointments, since 2021 involvement started. She has been helped with isolation, welfare checks, deep cleans, hoarding issues, chronic pain non medication management, and advocacy work. This is ongoing work and losing CLP hours or completely would be detrimental to this and result in poorer health and wellbeing again 

This is but a very small snapshot of the caseload that our practice CLPs have held since we first were granted this service in December 2020. This does not include the running of the vital community services that CLPs need time to do like the community allotment that patients tend to, the health walks, the mindfulness groups, the chair yoga etc. CLPs are also a vital resource for the many distressed walk-in/unscheduled patient attendances that occur in an area such as this for a listening ear and signposting in a timely fashion, that GPs can no longer offer. We as a practice cannot stress enough the importance the service has provided . Their days are full dealing with patients like these and making positive changes to their wellbeing and overall health. GP workload has increased significantly in the last 10 years, especially post pandemic. We are not trained to offer this sort of support. We also do not have the capability to do so in terms of time. Having a CLP has been the biggest (and quite possibly the only) positive change since the new contract for both patients and staff. ANY reduction in provision whether that be hours, continuity or services offered will have catastrophic impact on patient well-being in a deep end area. This will also be mirrored in vast reduction in GP access to appointments as we will have to absorb these consultations again with none of the resources. This will be a major factor in retention of primary care staff also and will likely be the last straw for some GPs who will move on elsewhere or take early retirement.  

We ask that this small snapshot be considered in terms of the vital importance of CLW provision, reducing the CLP staff numbers and spreading them over a bigger area is a not an improvement but a disaster!!! 

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