Objectives: This study aimed to describe social problems presented to general practitioners (GPs) in UK inner cities and GPs' responses; describe patients' help-seeking pathways; and consider how these pathways can be improved. Methods: The study involved a pilot survey and follow-up qualitative interviews with patients in two inner city areas in London and Salford in 2001-2. The pilot survey involved five practices in each locality. GPs completed questionnaires on 57 people presenting with social problems. A diversity sample of 12 patients were followed up for interview. Results: Study results are presented in two parts. This paper focuses on the GP survey results. People were presenting with a wide range of social problems, and multiple problems were also common. Problems with welfare benefits and housing were the most common, but GPs were most likely to refer to counselling services and to a lesser extent to generic advice services. Some GPs would have preferred to refer patients to more problem-specific services but did not believe these were available. Conclusions: The study highlights the role GPs play in helping people deal with social problems but also identifies limitations in their response to these problems. It points to the need for more integrated pathways to help and advice for social problems. Primary care can make existing pathways more visible and accessible, and create new pathways through, for example, the new commissioning role and extending the scope of social prescribing. Many commentators have highlighted the potential role for primary care in the public health arena.

Objectives: This study aimed to describe social problems presented to general practitioners (GPs) in UK inner cities and GPs' responses; describe patients help-seeking pathways; and consider how these pathways can be improved. Methods: The study involved a pilot survey and follow-up qualitative interviews with patients in two inner city areas in London and Salford in 2001-2. The pilot survey involved five practices in each locality. GPs completed questionnaires on 57 people presenting with social problems. A diversity sample of 12 patients was followed up for interview. Results: Study results are presented in two parts. Here (Part II) qualitative research results are reported highlighting four themes: the complex and enduring nature of social problems; the persistence people display seeking help; the fragmented and problematic pathways available; and the roles GPs play as: primary medical adviser; formal gateway to another service; advocates or facilitators to another service; and sources of support and advice during a process of recovery. Commonly, GPs occupied more than one role. Conclusions: GPs do help people deal with social problems, but their responses are limited. More integrated pathways to help and advice for social problems are needed. Existing pathways could be more visible and accessible, and new pathways developed through commissioning and extending social prescribing. More partnerships across sectors may create more co-ordinated provision, but these are notoriously difficult, and other trends such as the focus on lifestyle issues and long-standing conditions may make it more difficult for people with social needs to access support. T his is the second part of a two-part paper reporting on research that aimed to contribute to the development of a more effective role for general practice in particular and primary care in general in addressing the social causes of ill health. As we noted in Part I, 1 although many commentators have highlighted the potential role for primary care in the public health arena, 2-11 the development of a public health dimension to primary care has lacked strategic direction in the UK. In particular, the role of primary care in ameliorating the social causes of health inequalities has remained largely underdeveloped. Relevant background literature to the study was reviewed in Part I of the paper. In particular, in that paper we argued that whilst current models of the social causes of health inequalities highlight the multifactorial character of the pathways leading to health inequalities and are strongly social in their orientation, the macro perspective inherent in such models neglects the lived experience of inequalities at the individual level. Without this parallel micro focus, we suggest, explanations for health inequalities will tend to be deterministic in their orientation: failing to recognise that the individuals involved are not passive victims of social processes, but consciously act to protect and promote their own health and that of others, albeit within struc...

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EnglishThe qualitative research described in this article aims to explore the dynamics of routine public health practice and policy within two local health systems. Using a theoretical framework drawn from social science and management literatures on 'communities of practice ' (Wenger, 1998), we seek to illuminate the values and ideas that shape the way in which public health practice and policy making is 'done' on a routine basis. In particular, we suggest that people's narratives about their daily work resonate with the concepts of engagement, peripheral participation and marginalisation used in the communities of practice literature. FrançaisLa recherche qualitative décrite dans cet article cherche à explorer la dynamique de la pratique et de la politique routinières de la santé publique dans le cadre de deux systèmes de soins médicaux locaux. En utilisant un cadre théorique provenant des publications en sciences sociales et management sur les 'communautés de pratique' (Wenger, 1998), nous cherchons à mettre en lumière les valeurs et les idées qui déterminent la façon dont la pratique de la santé publique et les décisions politiques fonctionnent sur un mode de routine. En particulier, nous suggérons que les récits que font les gens de leur travail quotidien résonnent des concepts d'engagement, de participation et de marginalisation périphériques utilisés dans les publications ayant trait aux communautés de pratique. EspañolEl estudio de investigación cualitativo descrito en este artículo tiene como objetivo el explorar las dinámicas de la rutina en la práctica y política de la salud pública dentro de dos sistemas de salud locales. Utilizando un marco teórico sacado de los estudios de ciencias sociales y la administración en 'comunidades de práctica' (Wenger, 1998), buscamos iluminar los valores y las ideas que dan forma a la manera en la que la práctica de la salud pública y la elaboración política están hechas sobre una base rutinaria. Sobre todo, sugerimos que las narraciones de la gente acerca de su trabajo diario resuenan con los conceptos de compromisos, participación secundaria y la marginación usada en las comunidades de estudios prácticos.