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

Abstract

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.

Responses to concerns about child maltreatment: a qualitative study of GPs in England

“…This study was not designed to quantify how far the family types represent maltreatment-related concerns among all GPs in England but the families described by our participants are likely to be familiar within general practice. Descriptions of ‘on the edge’ and ‘stable at this point families’ were compatible with other descriptions of families and adults with social welfare problems in this setting 26. ‘On the edge’ narratives resonated with another well-known presentation: the ‘heart-sink’ patient.…”

Exploring the components and impact of social prescribing

“…Other studies found that 82% of patients decreased their number of health professional consultations (Popay et al, 2007) and there was a reduction in medical prescriptions (Age UK, 2012). However, Grant et al (2000) reported little decease in primary care use.…”

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

“…Part I of the paper focused on GPs’ perspectives on the social problems experienced by their patients and how they respond to these 1. Here we have described the wider help-seeking pathways followed by some of the patients included in the GP survey highlighting the complex and often long-term nature of the social problems presented to GPs; the resilience shown by people experiencing these social problems; the persistence with which they pursue help and advice; and the obstacles they face in seeking to manage their problems.…”

“…The design of the pilot survey of general practice consultation is described elsewhere 1. Here we describe the qualitative study of help-seeking pathways.…”

“…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.…”