My Community Links Worker is vital – here’s why

Dr Anthony McMahon reflects on the importance of the Community Links Worker within his GP surgery - and why it makes all the difference.

As a GP I chose to work in an area of high socio-economic deprivation.  

Dr Julian Tudor-Hart’s famous quote coined the Inverse Care Law more than 50 years ago. It tells us that “the availability of good medical care tends to vary inversely with the need for it in the population served.” 

An awareness of this unjust concept from an early career stage told me I was destined to be a Deep End GP. By that, I mean one of the doctors working in the 100 most socio-economically deprived practices in Scotland.  

However, this personal choice faces many challenges. Firstly, that population health outcomes are largely determined by the socio-economic environments in which we are born, grow, live, work and age and only in small part by the quality of the traditional healthcare we receive.  

Working with a CLW means the care I deliver can also have impact on these important socio-economic determinants at an individual patient level.  

I’ll give an example. During a consultation I undertake a mental health assessment, as I explore the factors that might be impacting the patient’s current mental state, I identify significant problems with finance, employment or housing, or maybe all three given the deprivation of the community. These could range from issues with; household budgeting, debt accumulation, DWP processes, or dampness, neighbour disputes, safety concerns or homelessness.  These issues are complex and in my role, unfortunately, I do not have the time or knowledge to adequately address them. However, they are relevant to health, even if not the focus of my medical-model assessment.  

Through CLW support and interventions, together we’re able to improve patient health by really impacting the issues that affect day to day quality of life, ease stress and emotional distress. This, potentially, also has further patient and system level benefits of reducing reliance on prescribed medications and need for intervention from stretched NHS mental health services.  

Another vital role of practice CLWs is in helping patients, often the most vulnerable, to navigate complex health and care systems or link with valuable local third sector opportunities. The CLW can act as a trusted, supportive hand to accompany patients in intimidating environments and situations. This can be invaluable for establishing or maintaining engagement with services and preventing further health deterioration. Afterall, disease prevention work is one of the cornerstones of primary care. 

Furthermore, one of the greatest benefits of having a CLW embedded within practices is that, in a way, there is really little they can’t do. If a member of the team has concern for a patient, in whatever aspect that may be- it’s an open-door policy. There are no specific tick-box criteria for eligibility. I believe, therein lies the beauty of the CLW-GP working partnership. People are complex and their health is affected by many things. GPs and CLWs working together as ‘generalists’ means that if you come to us, whatever the issue, with our complementing mix of knowledge and expertise, we’ll do our best to help.  

Ultimately, I suppose what I’m trying to say is, without a CLW in our team, our patient’s health would be poorer. I entered medicine to improve the health of others. I’ve come to realise in my medical role I can only do so much. However, working in partnership with a CLW we can achieve so much more- it’s a perfect pairing for meeting the health and social needs of those who need it most! Surely that’s one way to tackle the Inverse Care Law in the 21^st Century? 

I don’t know what I’d do without my CLW.  

End of page.