Primary Care Links Approach
The Primary Care Links Approach is a framework for development of general practice. It was developed by the GPs at the Deep End steering group and The Health and Social Care Alliance (Scotland). It attempts to support General Practitioners and other practice staff to become more community connected and equipped to support those on their practice list populations to deal with health issues that are biopsychosocial in nature, as opposed to purely medical.
Background
Inequalities, including health inequalities, that persist across populations of developed nations result in a high prevalence of social issues, as opposed to medical issues, consuming consultation times.[1]. Evidence suggests that the basis of good health is determined by 70% social factors compared to 30% physical[2]. The difference in healthy life expectancy – the number of years people can expect to live in good health, free from long term health conditions – between people living in Scotland’s most socioeconomically deprived communities, compared with those living in the most affluent is 10.5 years for males, and 8.5 years for females, as a result, the Inverse Care Law can be exacerbated and health inequalities widened[3].
This is a major contributory factor to the pressures currently faced by general practice, which, in the United Kingdom, are only likely to intensify as a consequence of the ageing population, among other wider societal factors and impacts of austerity policies in the UK, such as welfare reform[4][5].
It is in the context of these pressures on general practice and wider health care systems that the Links Approach emerged. Three primary care based projects that were active in Scotland between 2010 – 2013 helped shape the design of the approach[6][7][8]. The approach was first articulated in The Links Approach Conceptual Framework Paper, in 2014[9].
The Links Worker Programme
This paper was one of the founding, guiding pieces of work in the establishment of the Links Worker Programme, which is delivered by The Health and Social Care Alliance Scotland (The ALLIANCE) in partnership with the GPs at the Deep End group[10]. The programme was initially delivered across seven general practices in Glasgow, Scotland, who joined in 2014. A further eight practices, who had initially served to provide comparison data for an academic research study which was applied to the programme, joined in 2017[11]. Glasgow was chosen to host the initial tranche of the programme, to which the independent external academic evaluation was applied, due to the particularly pronounced impact of health inequalities, and disparity in life expectancy across social groups in the city, a phenomena known as ‘The Glasgow Effect’ which has been subject to much research and policy attention in recent decades[12].
The expansion of this programme formed part of the Scottish Government’s 2016 commitment to ‘recruit 250 links workers to work in general practices to help provide people living in areas of deprivation with the support they need’[13]. Funding for delivery of this wider rollout of links models will be channeled via local Health and Social Care Partnerships which are tasked with overseeing and delivering the integration of health and social care services across Scotland.
Capacities of the Links Appraoch
The links approach comprises seven identified capacities, development of which among general practice teams is intended to support staff to become more aware of resources within local communities, better able to manage this information, and to link their practice list populations with such, as well as a range of other activities including becoming equipped to better look after their own wellbeing. Together these aim to support general practice teams to be able to better address, and mitigate negative impacts of social determinants of health.
The rationale behind and details of each capacity are fully outlined in Defining the Links Approach Record of Learning Module[14]. A brief description of each is:
1. Team wellbeing Practices need to have a safe environment, team members need to have their personal wellbeing supported, and the primary care team needs to have sufficient time to listen and advise people.
2. Shared learning GP practices need to have protected time for sharing learning (within the practice and between practices), access to educational resources to develop knowledge and skills and the opportunity to share stories about experiences.
3. Awareness Clinicians and their administrative team need to be able to identify people who would benefit from information or support, to have a wider understanding of the social and personal context of illness, and a commitment to the outcome of self-management.
4. Intelligence Practice teams need to be able to actively gather information, to be able to curate and quality assure that information, and to have efficient and accessible processes for patients to receive this information at the point when it is needed and likely to be responded to.
5. Signposting Practice teams need to be able to routinely provide information about support to patients. This needs to be in accessible formats and delivered in a manner and timing when it is acceptable and meaningful.
6. Problem solving Practice teams need to be able to identify those people who are experiencing barriers to accessing resources, develop expertise in supporting people practically to find solutions to these barriers, and be able to offer motivational and relationship support in taking steps towards self-management.
7. Network building Primary care teams need to develop an extensive network of personal and word of mouth relationships in their local community, to facilitate or co-create innovative ways to match local assets and resources to identified unmet needs of their patients, and to provide practical and moral support to attempts within the community to protect and build local capacity.
Over the first three years of the programme participating practices were provided with a £15,000 per annum development grant which they used to fund activities and resources aimed at building these capacities within their staff teams. Record of Learning Module Implementing the Links Approach details the range of activities practices engaged with in furthering these[15].
In December 2017 the Scottish Government raised the prospect of disseminating the links approach to out of hours general practice provision[16]
References[edit]
- ↑ http://www.pulsetoday.co.uk/home/finance-and-practice-life-news/gps-spend-fifth-of-consultation-time-on-non-health-problems/20009996.article
- ↑ Marmot Review Team (2010) Fair Society, Healthy Lives: Strategic review of health inequalities in England post-2010 (The Marmot Review). London: Marmot Review Team. https://www.local.gov.uk/marmot-review-report-fair-society-healthy-lives
- ↑ General practice funding underpins the persistence of the inverse care law: crosssectional study in Scotland. G. McLean, B.Guthrie, SW Mercer, GC Watt. Br J Gen Pract. (2015) Dec;65(641):e799-805 https://www.ncbi.nlm.nih.gov/pubmed/26622032
- ↑ https://www.theguardian.com/society/2015/jan/19/nhs-we-have-not-fit-for-future-warns-top-doctor-bruce-keogh
- ↑ http://www.fph.org.uk/the_impact_of_the_uk_recession_and_welfare_reform_on_mental_health
- ↑ http://www.gov.scot/resource/0039/00393257.pdf
- ↑ https://www.gla.ac.uk/media/media_282275_en.pdf
- ↑ Improving Links in Primary Care Project Report. Health and Social Care Alliance Scotland and the Royal College of General Practitioners Scotland (2014).
- ↑ The Links Worker Programme: The Primary Care Links Approach Conceptual Framework. Peter Cawston (October 2013).
- ↑ https://www.alliance-scotland.org.uk/in-the-community/national-link-programme
- ↑ http://www.healthscotland.com/documents/29438.aspx
- ↑ http://www.gcph.co.uk/latest/news/636_new_synthesis_on_excess_mortality_published
- ↑ http://www.gov.scot/Publications/2016/09/2860
- ↑ https://www.alliance-scotland.org.uk/wp-content/uploads/2017/11/Defining-the-Links-Approach-Module-Final.pdf
- ↑ https://www.alliance-scotland.org.uk/wp-content/uploads/2017/11/Implementing-the-Links-Approach-Module-Final.pdf
- ↑ http://www.gov.scot/Publications/2017/12/2391
This article "Primary Care Links Approach" is from Wikipedia. The list of its authors can be seen in its historical and/or the page Edithistory:Primary Care Links Approach. Articles copied from Draft Namespace on Wikipedia could be seen on the Draft Namespace of Wikipedia and not main one.
