Guest post by Mark Kelvin – Programme Director National Links Worker Programme Health and Social Care Alliance Scotland (the ALLIANCE)
It is with some hesitancy that I write a blog reflecting on the modern-day visitation of ‘Care in the Community’. However good the concept, and however sound the values, the semantics often evoke memories of the cost-driven ambition of deinstitutionalization and ‘keeping people at home’.
It is again in an environment of austerity that the discussion of Care in the Community is taking place, so is anything different? Are we to believe that the motivation on this occasion is person-centred model of care? Does it even matter? If there’s a way of offering somebody a truly person-centred model of care that keeps them happy in their community for longer and in a way that’s light on the public purse – surely that’s a no-brainer?! So what’s the problem?
The National Links Worker Programme is a partnership project between the Health and Social Care Alliance Scotland and the GPs at The Deep End Steering Group, who are representative of General Practitioners working in the 100 practices serving the most socio-economically deprived populations in Scotland. It’s the first programme of its kind to explore this question with a focus on the primary care team.
The ageing workforce and struggle to recruit and retain new GPs is just one of the challenges facing primary care in Scotland. GPs, practice nurses, and their teams face a huge increase in demand for their services, and the nature of that demand is changing.
Previous research in Deep End practices has found that in one-in-four GP consultations, the person sought the help of their GP in relation to their social circumstances, for example poor housing, domestic abuse, and isolation/loneliness.
It’s right that people see their GP practice as a community health hub. GPs and their teams have often provided first-rate care to generations of the same family and as such have earned a deep level of trust. This natural source of support in the community is often the first point of access when citizens are in need of support. This change in the demand in services however is juxtaposed with the skill set of the traditional primary care team. That is until the introduction of the Community Links Practitioner.
As part of the Links Worker Programme, participating GP Practices host a Community Links Practitioner who supports people to identify goals and enable them to achieve those goals. They work with people to identify and enable access to local community assets (often through the ALISS online search engine) in an entirely person-centred way.
Connecting people in to their communities in this way is a vital upstream and preventative approach to health and wellbeing and Community Links Practitioners often support people who might find it difficult to access services alone. The programme works towards ‘self-determination theory’, which suggests that when a person has a high level of autonomy, health competence and relatedness, then they are better equipped to access the support and services available to them. Where people find it difficult to tap into these resources however, they are much more likely to succeed with a Community Links Practitioner by their side.
The Links Worker Programme isn’t limited to just individuals who work with the Community Links Practitioner. The Programme recognises the pressures and obstacles that the primary care team face in working more closely with their local community. The programme supports the GPs, practice nurses and receptionists to augment the capacities that they need for this to happen. A GP from a Links practice has recently reflected on her experiences of the programme and of getting to know her local community, you can read her reflections here.
The Links Worker Programme is a Randomised Control Trial and as such will provide a robust level of evidence in to the benefits of this approach. Official findings will be available in October 2016 but the results are already clear to the programme management team, with hundreds of people being supported to develop new friendships and identify new activities that are helping them to live well locally, this is truly what we mean when we talk about ‘care in the community’.