Background Co-locating welfare advice services in primary healthcare settings has been one approach to tackling health inequalities by increasing income among socially deprived individuals. It is also hoped to relieve pressure on general practices in supporting patients with ‘non-clinical’ needs. Previous evaluations have been methodologically limited and lack theoretical underpinning. We aimed to examine the impact of co-located welfare benefits and debt advice on mental health and primary care service use, and to develop theory linked to pathways of effect.
Methods A prospective, controlled quasi-experimental study with an embedded qualitative component was carried out (December 2015-December 2016) in eight intervention and nine comparator sites across North Thames, London. Before-and-after quantitative data were collected via self-report questionnaires. Comparison group members were propensity score weighted for analyses. Outcomes included change in symptoms of common mental disorder (CMD) (12-item General Health Questionnaire), well-being (Shortened Warwick and Edinburgh Mental Well-being Scale), three-month GP consultation rate and financial strain. Data from qualitative interviews with 24 primary care staff, funders and advice providers were analysed using a modified realist evaluation approach to understand how co-located welfare advice could influence practice outcomes.
Results For the quantitative study, n=285 and n=633 individuals were recruited into advice and comparison groups respectively at baseline. 72% and 84% were retained at 3 month follow-up. Relative to controls, CMD caseness reduced significantly among female and Black/Black British advice recipients. Individuals whose advice resulted in positive outcomes demonstrated significantly improved well-being scores. Significant reduction in financial strain overall but no change in three-month consultation rate was found. Per capita, advice recipients received £15 per £1 of funder investment. Qualitative findings were used to inform underlying theory linking service activity to general practice outcomes. These were reduced GP consultations for ‘non-clinical’ issues and reduced practice staff time supporting patients with such issues. The findings revealed key implementation, context and agency factors that facilitated or hindered the potential for co-located advice to influence these outcomes.
Conclusion Recipients of co-located welfare benefits and debt advice experience reduced financial strain and for sub-groups short term mental health is improved. Co-located advice services have the potential to support general practice work but not if co-location is limited to a physical sharing of space. Suggestions are made to facilitate joint working.
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