Manager Practice


Practice manager Elaine Smith


and below with Dr Peter Cawston


“


WHO WAS SO ANXIOUS HE WAS LITERALLY SHUT UP IN THE FAMILY HOME FOR 10 YEARS. HE STARTED COMING TO THE GROUP; HE’S NOW WORKING. IT’S AMAZING


WE’VE HAD A YOUNG MAN ”


“A great many health problems are caused by social conditions and GPs were being asked to address issues that were not medical and we weren’t equipped to deal with in a very effective way,” says Dr Cawston. “We strongly urged that the links worker should be part of the practice team and also that opportunity should be made for the whole practice to rethink how they approach social problems and become better at sign-posting – more aware of what’s available in the local community.”


ROLLER COASTER RIDE Margaret Ann Prentice is the links practitioner at Garscadden Burn and is employed by the Health and Social Care Alliance Scotland with support from Scottish Government. She is also considered a full member of the primary care team, seeing patients in a consultation room and also in their homes. The job is not an easy one and in a YouTube video she describes her typical week as a “roller coaster ride” – helping patients with issues such as adult and child protection orders, bereavement, rent arrears or threatened eviction, dealing with police and social workers, mental health issues, as well as promoting healthy living, including organised walks, yoga and cookery classes. Annette Fennell acts as links administrator in the practice in addition to her role as receptionist. Having a links worker has had a major impact on the practice,


says Elaine. “On a Friday afternoon a GP might come across someone with no money, no food and three children. The GP can then say ‘okay I’m going to refer you on to Margaret Ann’ and she can take over that patient.”


The scheme has also given GPs greater confidence to ask patients about underlying issues, such as debt or domestic violence, because they now feel able to offer an adequate response. So is it working? Evidence is due to be published later this year but from April 2014 and August 2016 there were 508 referrals to the links worker at Garscadden Burn and she was able to engage with 388 (76 per cent). A questionnaire sent to patients across the pilot found that 60 per cent of users reported improved wellbeing and 25 per cent reported significant improvement. “A lot of patients we would see week in, week out – we now see less


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of because their problems have been sorted out by Margaret Ann,” says Elaine. “They only need to speak with a doctor if they are genuinely ill.” Certainly evidence coming out of practices such as Garscadden Burn


has convinced the Scottish Government. It recently published an action plan involving the recruitment of 250 community links practitioners to work with GP surgeries across Scotland. Dr Cawston has been asked to advise on the implementation. “I think we are still a very ordinary practice with all the stresses and


strains and failings of ordinary practices,” he says “We don’t claim to be special in any way. But we do feel in a better place both in terms of team dynamics and morale. We have also been able to see really quite visible improvements for patients, especially those at the most difficult end of social problems. And I guess the reason we come to work, the thing that improves our morale, is feeling that we can make a difference – not just keeping our heads above water. We are actually managing to do something positive.”


Jim Killgore is publications editor at MDDUS


PHOTOGRAPHS: SHANNON TOFTS


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