At the Deep End: integrating money advice workers into GP practices

There is increasing recognition that embedding specialist money advice services in General Practice offers new ways to address some of today's major public health challenges. These include mitigating the negative impact of poverty and changes to the welfare system on people’s mental health, tackling longstanding poor health in deprived communities, and decreasing unnecessary workloads in practices. 

Addressing key challenges

Over the last three years, the Deep End Money Advice Project in north east Glasgow has been addressing some of these key challenges by putting more money in people’s pockets, lessening the burden of household debt and encouraging people to access other support services to improve their wellbeing and quality of life. This latest study shows that in 2017/18, the project achieved £1.5 million in financial gains and managed £470,000 of debt, in effect generating £25 for every £1 invested in the project.

People entitled to disability-related benefits have benefited the most from this project which is important as disabled people and their families continue to be among those hardest hit by welfare reform. The project also showed that GPs have a key role to play in tackling child poverty by routinely asking families about money worries, over-and-above the existing systems set up in 2010 (previously known as ‘Healthier Wealthier Children’) which are predominantly used by Health Visiting staff.

Other reported benefits include the GP practice being seen as a trusted and stigma free environment where people can be open about discussing their money worries. Some GPs believe that having access to on-site advice services eases their workload and reduces GP appointments for welfare-related concerns, thus saving time. Money advisors know that accessing medical evidence, after obtaining consent, empowers them to prepare high quality advice interventions to ensure that vulnerable people do not have to spend unnecessary, and at times stressful, amounts of time in the appeals system, thus reducing anxiety levels. This can enable advisors to support as many people as possible at a time when demand for their services is increasing, especially with the planned roll out of Universal Credit.

'Hidden' needs

It was worrying that the majority of people referred to the service had not accessed advice in the last year, apparently ‘hidden’ from mainstream advice services. Yet this type of demand is only likely to increase as the unprecedented cuts in welfare budgets continue. It is of equal concern that this latest study found households struggling on very low incomes that were either unaware of their entitlement to important benefits and supports (e.g. debt management, help with housing issues) or felt unable to access advice through other routes or settings.

Now that we have evidence of this injustice, and a proven person-centred delivery model to meet people’s needs, it is incumbent upon us to consider how we might strengthen (or reconfigure) existing advice service provision to reach more vulnerable people using local healthcare services. The approach adopted by this project not only echoes the aspiration in Glasgow’s Primary Care Improvement Plan that people are supported by different professionals working together, it also complements the roll out of the Community Link Worker role. After all, if we’re unable to support people to stabilise their precarious financial situation, how can we reasonably expect them to be in the right frame of mind to make coherent decisions and plan for their future? 

Moving forward

To that end, there is merit in exploring a hybrid approach which brings together the embedded model of advice provision in General Practice, mainly serving older adults who are unfit for work, with the universal referral pathway, which primarily addresses child poverty by supporting families. Offering everyone a money advice service in their own General Practice, regardless of their age or circumstances, would not only be the preferred setting for most people, it would also provide access to medical records and the advantages this confers, and move away from a more targeted approach which inevitably benefits some over others.

Moving forwards within a challenging welfare landscape, there is an opportunity to emulate the inclusive values of the new Scottish Social Security Agency ensuring that the provision of money advice and access to social security is the best possible experience for everyone we serve, including people accessing General Practice in the most deprived areas of Glasgow and Scotland.