Integrating Money Advice within Primary Care
Glasgow City Health and Social Care Partnership
Partner organisations: GEMAP Scotland Ltd, Glasgow Centre for Population Health, Deep End GPs, Associate Clinical Director NHS GGC
GP practices in the East of Glasgow cover some of the most deprived communities in Scotland. The issues surrounding poverty and household debt affect the physical and mental health of people and communities across Scotland. This in turn has an impact on how GP practices deliver services.
While a universal money advice referral pathway has been in place for several years, and GP’s recognise the importance of their patients accessing quality advice, data demonstrates they seldom use it.
Previous piloting of an embedded advice worker in two GP practices demonstrated that it can significantly increase referrals to advice services and provide patients with a quality service that alleviates poverty and meets their needs in a confidential and anonymous way.
This project scaled up the model within the Parkhead cluster area to address poverty by embedding a Money Advice worker in each GP practice a half day a week. The worker took referrals directly from the practice team, supporting the aspiration that practices will function with wider multi-disciplinary support.
Embedding advice and supporting practice ownership made a significant difference to referrals and the reach of advice services. Outcomes included income maximisation, mitigating welfare reform changes, supporting debt management and financial capability.
Over the course of the project there were a total of 665 referrals, of those 451 engaged with advice services, resulting in around £1.5 million in financial gains.
The project was supported by grant funding from the ihub's Improvement Fund in 2016-2017.
- What was the approach?
“Whilst there will always be practitioners who do not view referral to advice agencies as part of a treatment option, we anticipated that evidence of the effectiveness of this work, coupled with peer influences, would persuade colleagues to adopt the model.”
The model of GP clusters supports the aspiration that practices will function with wider multi-disciplinary support. Embedding money advice workers in each GP practice for a half day a week, should help tackle health inequalities and alleviate some of the health knock-on effects.
When the need for money advice is identified with the patient, and permission given, they are referred by the practice team to the advice provider (GEMAP) who triage their concerns and arrange appointments as required.
The money advice worker then undertakes an assessment, and supports any necessary interventions, such as benefit applications, income maximisation, and debt advice. Follow up appointments or referrals to other services are made as required.
Health improvement staff had a crucial brokering role to ensure:
- practice staff were briefed on the pilot aims and objectives
- the referral process was established and operating effectively
- set-up was supported and resources were in place
- good communication at all levels.
- What was the impact?
“The return for every £1 invested into the project was £25.”
There were a total of 665 referrals, of which 451 engaged with the advice service. Those seeking advice were more likely to be single women, older, unfit for work, and living in social housing. Working age adults made up the bulk of the client group, the majority with an income of less than £10,000.
Personal Independence Payment (PIP) and Employment Support Allowance (ESA) accounted for over half of the overall £1.5 million in gains for all advice uptake over the year.
214 people were supported on at least two advice issues, 182 received some type of financial gain, 108 were supported to manage debts, and 124 were referred on to other support services. These were often people with no prior contact with advice services, suggesting a potentially high level of unmet need.
- approximately £1.5 million in gains, over half for disability-related benefits
- support for household debt management totalled more than £470,000
- at a household level the average gain was £8,253, with negotiated debts averaging £4,356.
Over a quarter received onward referrals to other agencies and services – the most frequent reasons being homelessness and housing issues, followed by mental health support.
Accessing money advice through the GP practice was seen to reduce stigma and promoted uptake due to the discreet setting.
"Within a month of contact with [the advisor], found it wasn’t as bad as it seems. Very dramatic difference in a very short space of time, more than money advice – a face, added value, little things, like making sure he wrote everything down for me as he knew I’d forget."
The project was also seen to benefit the service. Some practice staff reported an easing of workload and reduction in welfare-related appointments, allowing them to concentrate on core clinical tasks.
- What was the learning?
“The outcomes were as expected. If anything it was possibly easier than expected to roll out the project due to an established track record of supporting advice delivery in other healthcare settings, existence of the GP cluster group, and agreement that this was a cluster priority.”
- North East Glasgow Money Advice project team
The team offered advice for others with similar projects:
- Strong buy-in from at least one key individual within the practice is paramount.
- Develop a service level agreement outlining the expectations and requirements of all partners, specifying key systems and processes required to ensure successful outcomes.
- Ring-fence time for a key operational lead to implement and operationalise the project to the standard that is expected and agreed.
- Establishing sustainable funding for the work is crucial. This model is tested and proven, and if resourced appropriately will generate the desired outcomes.
- Easy to understand feedback for the practice team was vital in reinforcing value and sustaining momentum.
These positive outcomes have seen the credibility of health improvement increase significantly in the locality, and to the wider Primary Care Implementation group. Sharing and reporting of the work has led to support for the trial and development of other health improvement initiatives such as smoking cessation and pop-up cervical screening clinics targeting vulnerable frequent non-attendees.
All data and evidence gathered from the service engagement is being shared with a range of key stakeholders, including the Deep End practices, the Glasgow HSCP Financial Inclusion and Equalities Leads, the GP Clinical Lead, Wheatley Group Head of Inclusion and Glasgow City Council’s Head of Financial Inclusion Services.
Scaling up this type of approach to cover Glasgow’s 80 Deep End GP practices has been estimated to cost £564,000 and could achieve around 8,300 referrals. Extending coverage across all of the city’s 146 practices was estimated at around £982,500 and could achieve an estimated 14,400 referrals.
Health service staff that become ‘benefit aware’ are more likely to refer over time. Therefore, we could expect engagement with this project and the number of referrals to increase across practices as the approach progresses. Integrating all referral pathways in such a way that leads to all healthcare professionals each doing a little to effect change across the life-course will avoid placing an unnecessary burden on GPs and contribute significantly towards tackling Glasgow’s rising poverty levels and persistent health inequalities.
- What are the next steps?
Feedback and results from this Improvement Fund supported project indicate this approach to debt management can help reconfigure NHS and partner funded advice services across NHS Greater Glasgow & Clyde.
The project has secured an additional year's funding from Clyde Gateway to continue to build on the learning and explore the development of employability supports for patients engaging with the project.
The project team have been actively raising the profile of this programme through local groups and networks and nationally via NHS Health Scotland and the Scottish Public Health Network, who have a key work stream around the impact of welfare reform.
As part of the Scottish Government plans to fund additional Community Links Workers, a draft briefing paper has been developed for HSCPs to consider the recruitment of a small number of money advisors in general practice via funding aligned to their Primary Care plans.