Practices, with the support of the Community Links Practitioner, are developing a business plan that aims to help the entire practice team to adopt a Links approach. This business plan follows a model of improvement and identifies 7 capacities that the practice need in order to be able to work more closely with their local community resources. The 7 capacities are:

1)    Team Wellbeing

A primary care team that’s in survival mode, or feels overwhelmed by demands cannot effectively offer patients support. The business plan must demonstrate how the team plans to support staff wellbeing and create an environment where there is enough time for staff to listen and advise people.

2)    Shared learning

GP practices need to have protected time for shared learning, access to educational resources and the opportunity to share stories.

3)  Awareness

Staff need to be able to identify people who would benefit from information or support, to have a wider understanding of the social context of illness.

4)    Intelligence

Practices need to be able to gather information, to curate that information and have efficient and accessible processes for people to receive this information. ALISS  will play a key role in meeting this need.

5)    Signposting

Practices need to be able to routinely proved information about local support to people.

6)    Problem Solving

Links Practitioners have capacity to work with people to identify and solve problems.

7)    Network building

Primary care teams need to develop an extensive network of personal relationships in their local community.

How will this benefit the practice population?

Along with adopting the Links approach that will benefit the entire practice population, the practices will focus on 5 themes taken from the Self  Management Strategy for Scotland:

1. Adapting to diagnosis
2. Living well day to day
3. Facing challenges and crises
4. Navigating systems
5. Dying well

By focusing on these 5 areas, and improving or further developing the practices process in order to support people experiencing these issues, we hope to robustly demonstrate the impact of the approach when compared to the comparison practices. Practices are currently agreeing which aspects to focus on under each of these headings.

A series of reports by the Deep End have described in detail the impact that living in complex social circumstances can have on people’s health. These reports have been from the perspective of the general practitioners who work in areas of “blanket deprivation”, that is communities where needs are intensively localised and clustered. One of these reports focused on the experience of social prescribing among GP practices in deprived areas. This report described a high proportion of consultations with GPs being driven primarily, or largely by the experience of social adversity, especially poverty and financial problems, as well as experiences of violence, addictions, housing and many other difficulties. The GPs felt that they were often unable to respond effectively to these because of a lack of time and with difficulties in accessing community-led services which they knew would benefit their patients. The GPs strongly identified with the need for a bio-psychosocial model of patient care, and expressed frustration at the barriers that prevented them from supporting patients in this way.

The Links Worker Programme, initially funded by Scottish Government as a pilot, is a Glasgow City HSCP funded programme, funded by Primary Care Improvement Fund . Delivery of the programme by the ALLIANCE is within 31 GP practices across Glasgow.  They are based within Deep End practices (GPs at the Deep End are collaborative of the 100 general practices serving the most socio­economically deprived populations in Scotland) and work with the practice multi-disciplinary team. The programme is guaranteed funding until December 2021.

The programme recognises the pressure that GPs and primary care colleagues are under. It introduces a different skill-set in to the practice team as well as support the existing staff to adopt the Links Approach.

The Community Links Practitioner

Our Community Links Practitioners all have a third sector or community development background and have 3 main responsibilities:

1. They’re working directly with practice population, particularly with people who are experiencing complex circumstances. They support people to identify goals an enable them to achieve those goals through identifying and enabling access to local community assets. Community Links Practitioners will work with people in the practice, the person’s home, and in the community. They will share the person’s journey for as long as it takes to enable them access to more specific or longer-term support.
2. They’re working with the entire primary care team, both clinical staff and non-clinical staff in order to enable them to adopt the Links Approach (see below). Links practices, with the support of the Community Links Practitioner, have developed a plan that aims to help the entire practice team to adopt a Links approach. This plan follows a model of improvement and identifies 7 capacities that previous studies have suggested the practice team will require in order to adopt the Links approach.
3. They’re working with local community resources, supporting them to become more accessible to people accessing them via primary care. This includes making them aware of ALISS and how that helps the primary care team to find them.

The Links Approach

The Links Approach is a primary care team development approach which engages the entire team in developing the capacity to support people to live well in their community through enabling better access to information, knowledge, skills, relationships and resources. The links approach was piloted in the 2011 Deep End Links Project and has been developed by the recent Bridge Project and Improving Links Project.

Rationale

The rationale for links workers is that if individuals feel supported in their lives, then they are more likely to respond to information on ways to improve their health and to live well. If these people were to be successfully supported sooner rather than later then there is a potential that their risk of developing long term conditions would be reduced or further complications delayed or prevented if have already contracted long term illness(es).