Citizens Advice in GP practices

Citizens Advice (CAB) was originally trialled in GP practices in Birmingham in the early 1990s. The rationale is that many influences on health are wider than the medical factors that GPs can deal with. For example, the amount of money a family has to spend, their quality of housing, if they have a job or are unemployed and the level of education they achieved all have a strong influence on peopleís health. The diagram below captures all these influences set out in different layers.

Influences on health (Dahlgren & Whitehead 1991)

As individuals, we can do something about some of these influences, such as eating well and not smoking but we canít do much about some of the others, such as being unemployed when there are very few jobs available, or having to live in an overcrowded house if we canít afford to move. Citizens Advice can help with some of these issues. For example, they can check if people are receiving their full benefit entitlements and they can help people to manage their debts or challenge unfair employment practices.

By placing CAB advisors in GP surgeries, we can help doctors to help patients with social and financial problems that could impair their health if they are not addressed. It is an Ďupstreamí intervention, designed to prevent people from becoming ill due to social problems. The service has been available in Derbyshire since 1995 (one practice) and is now available in 94 out of the 102 GP practices in Derbyshire County. It is popular with patients, GPs and the rest of the primary health care team. The service secures millions of pounds of extra money for Derbyshire families every year and helps them to manage millions of pounds of debt. Research by the University of Sheffield shows that this service is very likely to improve the health of the people receiving CAB advice and it is considered good value for money by the local NHS and Derbyshire County Council. Specific outcomes can be found on other links of this website.

Julie Hirst
Public Health Specialist
NHS Derbyshire County
16th July 2012