Providing advice on benefit entitlements and debt in a primary care setting can help people who might not otherwise have sought advice. Richard Bundy reports

A wealth of recent research confirms that poverty is bad for you. The April 1999 IMS Health Survey found that money worries were the most frequently cited cause of depression, closely followed by death and illness in the family, work worries and relationship problems.

The report also found that surgery time spent dealing with depression-hit patients had increased from 4 million hours in 1994 to 9 million hours in 1998. Depression now costs the country more than£8bn a year.

Over the past few years, advice agencies in different parts of the country have been working with GP practices to provide advice in primary health locations, particularly on benefit entitlement and debt.

This is quite well established in the West Midlands, where Birmingham District and Sandwell Citizens Advice Bureau has a number of advice sessions in health centres and GP practices.

1In other areas, such as Derbyshire and Wigan, local authority welfare rights services have developed this work.

2In 1997, with the help of the government's single regeneration budget, a project was set up in the Broughton area of Salford that took the concept a step further. The Broughton health project was not just a partnership between an advice agency and primary health teams, but between the two main advice providers in the city - Salford District CAB and Salford city council welfare rights and debt advice service.

Each employs a dedicated advice worker/welfare rights officer. Together they provide advice sessions, on different days of the week, from the two health centres. There is also a weekly session provided by the CAB adviser at an additional GP practice.

Where patients consent, the working relationship between the two allows for mutual referrals so the strengths of both agencies are brought to bear.

The work undertaken to date has involved:

direct advice through weekly appointment-based sessions;

mailshots offering benefit checks to patients aged 75 and over;

training for primary health professionals to help identify potential entitlements and referrals;

home-visiting, which is important for those who are frail, have disabilities or commitments.

Key groups of people can be reached by providing advice in primary care settings - 75 per cent of the people seen said they only sought advice because it was available in their health centre or GP practice.

Monthly mailshots to people over 75 have been particularly valuable in identifying older people living below the government's minimum income guarantee. Similar work has recently been undertaken in Lancashire's Ribble Valley.

3In 1999-2000, a third of the people seen were referred directly by a healthcare professional.

4The intervention required was 43 per cent advice only, 32 per cent form completion and 25 per cent appeals, reviews or negotiation.

The problems dealt with were 93 per cent benefitrelated - with 40 per cent relating to disability living allowance/attendance allowance and 17 per cent to income support.

Of the 350 new people assisted, nearly 1,200 problems were dealt with and the financial outcome for patients amounted to£129,000 in lump-sum payments and£482,000 in additional annual income.

A staff questionnaire circulated last year found that 91 per cent of health staff had referred patients and 84 per cent had received positive feedback from those referred. Significantly, 44 per cent felt there had been a noticeable reduction in the number of subsequent visits from those patients referred.

Initial research conducted by Liverpool University supports significant anecdotal evidence that such a service has a measurable impact on the health of those whose income increases after receiving advice.

5The university is undertaking research on a wider basis. The Broughton health project is one of the participating sites.

The service is valued by GPs, primary care staff and patients. It represents an important contribution to the building of a range of complementary services within health settings - the 'one-stop shop' envisaged by the government.

REFERENCES

1 Strachan P (ed).Health and Advice Services - Working Together. NACAB Southern Area Office, 1995.

2 Derbyshire County Council Welfare Rights Service. Welfare Rights in Primary Care, 1997; Prescribing Benefits to Patients, 1998. Wigan and Leigh Specialist Health Promotion Service.Working Together: Welfare Rights in Primary Care, 1998.

3 Healthy, Wealthy & Wise.(In Practice) Benefits, April/May 2000.

4 Salford Welfare Rights Service/Salford District CAB.Broughton Health Project Report, 2000.

5 Abbott S, Hobby L. An Evaluation of the Health and Advice Project: its impact on the health of those using the service.Health and Community Care Research Unit, Liverpool University, 1999.