Review of 2016 by the National Links Worker Programme
As is the way with a programme such as Links, 2016 has been typically busy. Each Community Links Practitioner will have worked with over 100 different individuals over the course of the year, continuing to support people to live well in their community, identify and address social issues that impact their health, and engage with useful community resources in doing so.
The nature of much of the CLP’s one-to-one work continues to be highly complex, often supporting people to unpick and work on multiple issues over a period of time. That they meet with many individuals on several occasions, often over long periods of time, not only reflects the prevalence of complex needs, but also mirrors the nature of public engagement with general practice itself, imbued as it is by serial encounters.
This wordcloud depicts the relative prevalence of common issues CLP’s work with people regarding.
Since Links commenced delivery three years ago a key objective desired by the Scottish government has been to help develop the evidence base around this way of working. Part of meeting this commitment has involved working closely with a team from University of Glasgow’s Institute of Health and Wellbeing, who are undertaking an independently commissioned quasi-experimental evaluation study to investigate effectiveness of the programme.
In recent weeks the university team have been able to confirm that they have received enough respondents to a nine month follow up questionnaire to allow for adequate power calculations to be applied to their comparison between results from patients of links practices and other practices.
Achieving this has involved a tremendous effort on the part of everyone involved in the programme across the seven intervention practices. Obtaining such data via the very fluid, reactive environment of general practice, especially in areas challenged by socioeconomic deprivation is notoriously difficult.
It means that the CLP role will be the first ever primary care team member role to be rigorously evaluated, not to mention having been designed in and for the areas that suffer from the worst health inequalities. And we will, in early 2017, discover whether the visible improvements we can all bring to mind witnessing in so many individuals over the course of the programme, have been picked up by the quality of life and mental wellbeing assessment tools used in the university’s methodology.
The past year has also seen some interesting findings emerge from various other pieces of evaluation work already undertaken on the programme. These include:
- Community resources in neighbourhoods where the programme is active report an increase in referrals received from general practice.
- Resources are finding that these referrals are more appropriate and relevant to the work they do.
- 61% of referrals to a CLP live in the most deprived 10% of Scottish postcode areas, 83% in the most deprived 20% of areas.
- The more often a participant has seen a CLP the more likely they are to report that there has been a perceived improvement in their wellbeing.
- Compared with the average for all Scottish practices over the three years the programme has been live, staff in participating links practices show increases in satisfaction levels across four (workload, teamwork, leadership and safety systems & learning) of the five thematic areas of the annual Patient Safety Climate Survey. In the fifth area, communication, the increase of links practices was, from an already greater baseline score, almost as great as the Scottish average. See the chart below:
All of this is very encouraging and alongside the results of the key outcome measures from the formal evaluation and other learning produced by the programme, such as that captured in the Record of Learning documents, of which another six modules where produced in 2016, means that the programme has already successfully provided much material, with the potential still to produce much more. This can help inform how the Scottish Government’s commitment to recruit 250 links workers to work in general practice in deprived areas will shape up over the next few years.
The community development side of the programme has produced some other notable highlights of the past year, with this tenet of the programme becoming increasingly prominent as the links approach model as the model becomes more deeply embedded within the practices and neighbourhoods where it is active.
Amongst these have been the further development of the ‘Promising Links’ patient group at a links practice, which is going from strength to strength and drawing in further support for their activities. This sees patients come together as a group to explore how to tackle issues which they collectively decide to prioritise, the first one of these being loneliness and social isolation. Winter workshops are running again at another practice. This sees patients engage with National Trust for Scotland Outreach team to engage with nature based activities throughout the winter months, building on the success of the local craft group which has been established as an offshoot of the practice walking group.
There are various other examples of developments on this side of the programme, such as partnering in establishing parenting programmes, gardening groups and adult cycling classes. All of which offers hope for the future and a reasonable expectation that the programme can continue to coherently work with communities to further build their resilience and have within themselves the solutions to many of the challenges they face.
All in all much excitement exists for what can be achieved in the future both in terms of evolution of the current programme and as to benefits being brought on a wider scale through wider rollout of the links model. Observing these benefits in communities is the ultimate recognition of the work the programme undertakes although the more such benefits are felt the more likely the programme is to be further recognised in the future, as it has been this year being nominated as a finalist in the Perfect Partnership Award at the Scottish Charity Awards.
A further notable achievement of 2016 was the award of Scotland’s Best Practice Team from Royal College of General Practitioners Scotland to the Links pilot practice, where our clinical lead is based, in recognition of their many forward thinking innovations, many of which have been inspired by links. So, particular congratulations go to everyone there at Garscadden Burn Medical Practice!!