Embedded welfare advice in GP surgeries

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The context

We know from recent (2018) health and homelessness research in Scotland that people who have experienced homelessness are, as a group, more likely to interact with health services than those who have not. We also know health activity for those people rose in the period leading up to a homelessness assessment. Research on homelessness in England found GPs are one of the most common services people access after a housing issue has occurred, but before they’ve been to housing options.

This indicates GPs have key opportunities to prevent homelessness. In 2020 Scottish Public Health Network reported that 100 welfare advisers were based in GP practices. This embedded model shows what can be achieved for people from a housing, as well as a financial inclusion, perspective.

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The intervention

Glasgow ‘deep end’ GPs found they were spending increasing time on patients’ socio-economic problems: problems which impacted health, but had no clinical solution. If patients trusted their GP enough to disclose money worries, it might follow that they’d act on the GP’s suggestion to see a welfare adviser. Locating the advice service within the surgery made this easier for patients, and reduced stigma.

In 2017, following a successful pilot embedding a money advice worker in two ‘deep end’ GP practices in Parkhead, the service was expanded to cover nine surgeries in North East Glasgow. Three advisers were embedded in practice teams. Administrative staff were able to make advice appointments on NHS systems for patients, and with appropriate consent, advisers had access to medical records. Various members of practice staff, such as GPs, health visitors and nurses could make referrals.

Access to medical records enabled welfare advisers to obtain accurate evidence to submit and support benefit and other financial applications, increasing the chance of right first time positive decisions, thereby reducing the potential for appeals: a process which can be long, stressful and resource-intensive for claimants, some of whom may abandon the process before its conclusion. Welfare advisers also referred patients onto other sources of community support where needed.  

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The outcome

Over a year, GP practices referred 654 patients to welfare advice, with high uptake. Advisers secured £1.5million in financial gains, of which £470,000 related to household debt, including rent and Council Tax. Housing and homelessness reasons made up over a third onward referrals - by far the largest proportion of these. 71% of referrals with housing status recorded were tenants (11% private; 60% social) and 13% were owners. 85% of patients hadn’t used any advice service in the past year. They were often unaware of their entitlements and/or felt unable to ask for help through existing routes.

Healthcare staff were already able to make advice referrals to locality services. Yet referrals to the embedded workers in nine surgeries exceeded those of all health staff in 35 surgeries in the locality. GPs made 87% of referrals, being more proactive asking about money worries knowing a trusted expert was on site. Monitoring shows for each £1 invested, around £25 in financial gain was generated.

This example does not evidence that homelessness was prevented for any patient. But the level of housing-related issues/gains, lack of prior service use and high take-up of advice shows the role GP-led intervention can play in reducing homelessness risk for some of the most disadvantaged patients.

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Key insights

•  trusted, universal professionals like GPs are able to engage some people at higher homelessness risk who may not disclose problems to, or act on advice from, other services (including landlords)
• making financial (or housing) situation a subject of routine enquiry by GPs can help overcome the stigma barrier around accessing earlier help which can prevent homelessness
• a high proportion of patients accessing advice via GPs were social tenants: there may be various reasons why they hadn’t accessed advice through their landlord, but this deserves further scrutiny

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Find out more…

Carol McGurin, Health Improvement Senior: Financial Inclusion, Glasgow H&SCP
carol.mcgurin@ggc.scot.nhs.uk