Developing public health work in local health systems

Popay, Jennie; Mallinson, Sara; Kowarzik, Ute; MacKian, Sara; Busby, Helen; Elliot, H.

doi:10.1191/1463423604pc224oa

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…As this research has illustrated, social problems are often complex, and responding to them can be a frustrating experience for GPs. Related research has found that community nurses also feel frustrated by their attempts to respond to the social causes of ill health, feeling that this work is not valued and receiving little support at an organisational level 39 42. It appears that primary care practitioners invest a considerable amount of time with patients experiencing social problems, so improving their referral options could save professional time, make their work more satisfying and address the social causes of health inequalities more effectively.…”

Section: Discussionmentioning

confidence: 99%

“…The research was part of a larger programme of work on the relationship between public health and primary care in two local health systems in England 12 37 – 39. The study reported on in parts 1 and 2 of this paper focused on the pathways people follow as they seek help to manage the social problems associated with health inequalities and to consider, in particular, the role of general practice and primary care in these pathways.…”

Section: Introductionmentioning

confidence: 99%

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Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part I: the GP perspective

Popay

Kowarzik

Mallinson

et al. 2007

Journal of Epidemiology & Community Health

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part I: the GP perspective

Popay

Kowarzik

Mallinson

et al. 2007

Journal of Epidemiology & Community Health

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“…Interview transcripts were read extensively and a thematic index (of the overarching concepts of definition of fall, establishing a cause, instinct, environment, physical issues, mobility, willingness to go to hospital, other professionals, social aspects and miscellaneous) developed after discussion between two researchers. Two transcripts were independently indexed by two researchers and then compared to ensure transparency 17. Summaries and direct quotes from the transcripts were placed into a table depicting the thematic index.…”

Section: Methodsmentioning

confidence: 99%

Complexity of the decision-making process of ambulance staff for assessment and referral of older people who have fallen: a qualitative study

Halter

Vernon²,

Snooks

et al. 2010

Emergency Medicine Journal

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BackgroundOlder people who fall commonly present to the emergency ambulance service, and approximately 40% are not conveyed to the emergency department (ED), despite an historic lack of formal training for such decisions. This study aimed to understand the decisionmaking processes of emergency ambulance staff with older people who have fallen. Methods During 2005 ambulance staff in London tested a clinical assessment tool for use with the older person who had fallen. Documented use of the tool was low. Following the trial, 12 staff participated in semistructured interviews. Interviews were recorded and transcribed. Thematic analysis was carried out. Results The interviews revealed a similar assessment and decision-making process among participants: < Prearrival: forming an early opinion from information from the emergency call. < Initial contact: assessing the need for any immediate action and establishing a rapport. < Continuing assessment: gathering and assimilating medical and social information. < Making a conveyance decision: negotiation, referral and professional defence, using professional experience and instinct. Conclusions An assessment process was described that highlights the complexity of making decisions about whether or not to convey older people who fall and present to the emergency ambulance service, and a predominance of informal decision-making processes. The need for support for ambulance staff in this area was highlighted, generating a significant challenge to those with education roles in the ambulance service. Further research is needed to look at how new care pathways, which offer an alternative to the ED may influence decision making around non-conveyance. BACKGROUND

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“…Traditionally, for example, general practice in the UK has resisted becoming involved in public health practice focusing on the wider social causes of ill health, and multidisciplinary working faces many barriers 15 – 17. There has been relatively little in the way of experimentation with social models of primary care, such as the Community Oriented Primary Care model developed in other countries 7.…”

Section: Discussionmentioning

confidence: 99%

Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part II: lay perspectives

Popay

Kowarzik

Mallinson

et al. 2007

Journal of Epidemiology & Community Health

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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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Developing public health work in local health systems

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Cited by 11 publications

References 10 publications

Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part I: the GP perspective

Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part I: the GP perspective

Complexity of the decision-making process of ambulance staff for assessment and referral of older people who have fallen: a qualitative study

Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. Part II: lay perspectives

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