Easing the burden on primary care in deprived urban areas: a service model

Abstract

The Primary Care Deprivation Initiative (PCDI) has been established in a deprived part of inner-city Liverpool in three health centres, in order to improve the capacity of the primary health care teams (PHCTs) to address the health and social care needs of part of the practice populations. Non-professional PCDI support workers, supervised by an experienced nurse, offer advice, support, information and, where necessary, advocacy to patients referred by PHCT members who present with mixed health and social care needs. The aim of the present study was to discover whether the PCDI eases the burden on the PHCT by reducing presentations to health staff of primarily social problems, or whether PCDI clients might make increased demands on the PHCT as a result of the PCDI being available. Routinely collected data on the use of primary care services were compared. Data collected for 12 months before and after accessing the PCDI showed statistically significant reductions in GP consultations and new prescriptions. There was also a definite but statistically non-significant increase in prescribing as a whole. It is concluded that, in the case of patients presenting with undifferentiated heath and social needs, the provision of services to separate and address the latter appears to result in more appropriate use of primary care by patients and more effective prescribing by GPs.