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 is a Scottish Government funded programme which aims at researching how the primary care team can mitigate the impact of the social determinants of health. The programme is being delivered as a partnership between the Health and Social Care Alliance (The ALLIANCE) and General Practitioners at the Deep End (The Deep End), and delivery partners include SAMH and the Royal College of General Practitioners (RCGP). The programme is guaranteed funding until March 2019 and is accompanied by a quasi-experimental designed piece of research conducted by the University of Glasgow.
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:
- 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.
- 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.
- 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.
The Community Links Manager
The programme also sees the creation of a Community Links Manager (Roseann Logan). Roseann is able to offer direct support to community resources, aiming to increase their capacity to support people in their local community, particularly those who may seek access to services through their GP practice. This involves working closely with different stakeholders to ascertain development needs and aspirations and to co-create meaningful and effective solutions that maximise their contribution in a community-orientated approach to primary care.
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).