Co-located welfare advice in general practice: a realist qualitative study

Woodhead, C., Collins, H. , Lomas, R. and Raine, R. (2017) Co-located welfare advice in general practice: a realist qualitative study. Health and Social Care in the Community, 25(6), pp. 1794-1804. (doi: 10.1111/hsc.12453) (PMID:28569395)

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General practitioners (GPs) engage with patients about a variety of social issues distinct from direct clinical work (“non-health” issues), such as health-related benefits and debt. Co-located welfare advice services could provide support to practices but have usually been considered in terms of patient rather than practice outcomes. We aimed to develop an initial programme theory for how the provision of co-located advice supports specific practice outcomes, and to identify salient barriers and enabling factors. Twenty-four semi-structured interviews with general practice staff, advice staff and service funders in two UK urban localities were conducted between January and July 2016. Data were thematically analysed and a modified Realist Evaluation approach informed the topic guide, thematic analysis and interpretation. Two outcomes are described linked to participant accounts of the impact of such non-health work on practices: reduction of GP consultations linked to non-health issues and reduced practice time spent on non-health issues. We found that individual responses and actions influencing service awareness were key facilitators to each of the practice outcomes, including proactive engagement, communication, regular reminders and feedback between advice staff, practice managers and funders. Facilitating implementation factors were: not limiting access to GP referral, and offering booked appointments and advice on a broader range of issues responsive to local need. Key barriers included pre-existing sociocultural and organisational rules and norms largely outside of the control of service implementers, which maintained perceptions of the GP as the “go-to-location”. We conclude that co-location of welfare advice services alone is unlikely to enable positive outcomes for practices and suggest several factors amenable to intervention that could enhance the potential for co-location to meet desired objectives.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Collins, Dr Hilllary
Authors: Woodhead, C., Collins, H., Lomas, R., and Raine, R.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
Journal Name:Health and Social Care in the Community
ISSN (Online):1365-2524
Published Online:01 June 2017

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