Analysis of membership survey re working in Primary Care & the NHS

BASW Cymru Membership survey analysis

Multi-Professional Roles within the Transforming Primary Care Model

Allison Hulmes, Professional Officer, BASW Cymru

  1. Name of your profession/practitioner role

Profession: Social Work

Practitioner role: Professional Officer at British Association of Social Workers - Cymru (BASW Cymru).

  • Analysis of national social work policy, research, workforce and professional development priorities across diverse parts of social work.
  • Representing and supporting membership.
  • Working with a broad sector of stakeholders and promoting ethical social work values and excellent practice.
  • Responding to national and regional consultations.
  • Understanding and analysing social work and related research
  • Presenting to diverse audiences.
  • Training and facilitation.
  • Media/Social Media representation.
  • Undertaking research.
  1. Please describe the contribution of your profession/practitioner role to transforming the NHS in Wales in relation to the primary care model.  This may be through a range of roles and needs to include primary and community care.

Social work is a regulated profession. Social workers are experts in the following areas which support primary care:

- Building relationships to understand people’s complex needs, negotiate around competing needs and rights, and resolve challenging situations 

- Intervening to build resilience, develop informal and community support, and promote skills for independent living

- Coordinating a range of practical and emotional support to enable social inclusion and to meet individuals’ needs and aspirations.

- Social workers have particular skills and knowledge, recognised in statutory guidance (Social Services and Wellbeing (Wales) Act 2014, Mental Capacity Act 2005, Mental Health Act 1983) to support individuals at risk of abuse and neglect; who may lack capacity to make decisions; whose ability to manage daily life is affected by mental illness or drug or alcohol problems; or whose mental and emotional health is affected by social and environmental factors, discrimination or adverse life experiences.

- Social workers provide holistic bio-psycho-social assessment with a focus on individual history, relationships and context. They work closely with individuals, families and communities to identify outcomes. They contribute to or lead planning to increase people’s independence and well-being.

- Social work training emphasises relationship-based, co-production and analytical approaches using sound evidence, ethics, law and theory. Social workers support people through complex, uncertain situations, including major life changes such as bereavement and end of life. Social workers provide advice and support to other professionals to enable preventative work, safeguarding, reablement and independent living.

  1. Please describe how your roles in primary and community care can improve access to appropriate services.  Please identify where your profession/ practitioner role can add capacity and capability through specific skills, competencies and experience.

Social workers have a role in providing Information, advice and assistance (IAA) - the purpose of the service is to provide people with information and advice relating to care and support, including support for carers, and to provide assistance to them in accessing it. Information, advice and assistance must be provided in a manner that makes it accessible to the individual for whom it is intended. IAA should be highly effective in signposting people at an early, preventative stage or identifying, once again, at an early stage, where a person needs proportionate assessment to access assistance. This could include referral or liaison with a GP or allied health professionals.

Social workers have been deepening their knowledge and skills in promoting independence at home, supporting resilience and capacity building in families/communities, since the publication of ‘Sustainable Social Services: A Framework for Action’ in February 2011. Most social work happens in people’s homes, whether the person has a disability, is a child, an older person, a carer or someone struggling with their mental health. By developing trusting relationships, social workers use their skill to identify when a person may need to seek the support of a GP or an allied health professional, at an earlier stage. This can offset the need for secondary/residential care and prevent escalation of need. Social workers are also able to affect behaviour change directly, using motivational interviewing and solution focused brief therapy. Both types of interventions can happen in a person’s home or even in a primary care hub. Changing risky behaviour – whether to health or vulnerable children/adults helps to prevent family breakdown (and the associated human and health cost) but can also slow down or prevent the development of chronic health/mental health conditions. This can reduce frequent visits to a GP, frees up GP time and supports them in using their time more productively.

Social workers can ensure that social needs are considered alongside health and are met in a coordinated way within the community. Areas in which social workers can effectively support primary care include:

  • Engagement with hard to reach individuals and communities
  • Advice, information and advocacy, including planning ahead to meet future care needs
  • Support for people to build independence and re-engage with communities
  • Support for people at risk of hospital admission or care home admission due to frailty or multiple long-term conditions
  • Support for people who are at risk of abuse and neglect
  • Support for people with complex social and economic needs such as homelessness
  • Support for people with health problems exacerbated by environmental circumstances such as poverty and discrimination
  • Support for carers who are experiencing or at risk of break-down or hardship
  • Support for people who require bio-psycho-social support at end of life and their families, including bereavement support.
  • The development of social prescribing offers opportunity for more joined up health and social support. This is enabled by a co-ordinator to work closely with patients and match them with community support. Without a skilled person in this role, social prescribing may add cost without reducing demands on primary care.[1]  This is an area where social work expertise can deliver.
  • NICE[2] identified evidence that primary care staff recognise their inability to address the social care needs of older people with complex needs and hypothesise that having a social worker in the practice would improve outcomes for people in need of practical, financial and social support.
  • NICE Guidance (out to consultation at present) recommends that health practitioners make prompt referrals for social care assessments and recommends a single coordinator to act as first point of contact for people with long-term conditions. Social workers are well placed to fulfil this role.
  • Social issues are usually complex and take up valuable time, often requiring ongoing support to resolve. It makes sense, as well as investing in GPs and allied health professionals, to invest in social workers to provide essential social support.

[1] Brandling J and House W (2009) Social prescribing in general practice: adding meaning to medicine. Br J Gen Pract. 2009 Jun 1; 59(563): 454–456

[2] NICE (2015) Social care of older people with complex care needs and multiple long-term conditions, Draft for consultation

  1. What measures could be (or are being) used to demonstrate improved access to your roles?

Breaking down some of the barriers to shared IT systems and use of data/information between health and social care is crucial to improving access.

Data on the number of assessments undertaken (including carers) by social workers and how many care and support plans flow from this, is gathered annually by local authorities. Better methodology needs to be developed to properly measure access and well-being outcomes, from both a quantitative and qualitative perspective.

Co-location in primary care hubs would improve access to social workers outside of more traditional roles, it would also help to break down many of the myths that exist about one another’s roles, improve communication and foster respectful relationships between social workers, GP’s and allied health professionals – this can only be positive for citizens in Wales.

  1. Please cite evidence (national and international) for the impact of your roles within the primary and community care setting where this available.

Brandling J and House W (2009) Social prescribing in general practice: adding meaning to medicine. Br J Gen Pract. 2009 Jun 1; 59(563): 454–456.

NICE (2015) Social care of older people with complex care needs and multiple long-term conditions, Draft for consultation.

GPs and Social Workers: Partners for Better Care Delivering health and social care integration together - A report by The College of Social Work and the Royal College of General Practitioner October 2014

Health benefits of primary care social work for adults with complex health and social needs: a systematic review Jules McGregor MA (Hons) MSW MRes1 , Stewart W. Mercer MBChB PhD FRCGP2 and Fiona M. Harris MA PhD3 1 Health and Social Care Department, City of Edinburgh Council, Edinburgh, UK, 2 Department of Primary Care Research, University of Glasgow, Glasgow, UK and 3 NMAHP Research Unit, University of Stirling, Stirling, UK Health and Social Care in the Community (2018) 26(1), 1–13

Primary Care Home Evaluating a new model of primary care Research report Stephanie Kumpunen, Rebecca Rosen, Lucia Kossarova, Chris Sherlaw-Johnson August 2017

  1. Where are your roles currently operating in primary and community care in Wales
  1. Most social work in Wales currently takes place in local authorities, though local authorities also base social workers in hospitals and in multi-disciplinary teams. There is also a small, but growing number of social workers in third sector organisations – Action for Children, NSPCC, KIM Inspire, British Red Cross.
  1. Please describe the professional requirements to fulfil the potential of your roles in primary and community care with consideration of the following:
  • Qualifications
  • Skills and competencies
  • Training and development
  • Supervision and mentorship
  • CPD opportunities
  • Career ladder
  • Other (not identified above but of importance to your profession)

The Continuous Professional Education and Learning (CPEL) framework for social workers is being further developed and the qualifying degree has been reviewed. In both cases, multidisciplinary working and joint learning has emerged as areas for development. CPEL needs further development to support social workers working in a more varied range of settings with a wider variety of employers. Having a clear career ladder for social work is still something that we must achieve.

Development of integrated training pathways needs to be explored further. Salford University offers an integrated social work and learning disability nursing programme.

MORE HERE:

http://www.cpel.ac.uk

http://www.salford.ac.uk/ug-courses/integrated-practice-in-learning-disabilities-nursing-and-social-work

  1. What do you consider are important employment considerations to further develop your role(s) within primary and community care in Wales?  You could consider:
  • Contracts
  • Job Descriptions
  • Indemnity
  • Pension issues
  • Funding
  • Training and working environment
  • Other (not identified above but of importance to your profession)

Contracts: Who will the employer be if social workers employed in primary care settings/hubs?  How will this impact on terms and conditions, training and pensions? How will the profession influence and lead what job descriptions look like? Who will ensure that social workers training and continued professional development needs are adequately met? Who will ensure social workers receive appropriate supervision?

Membership of BASW, the professional body for social workers comes with an automatic indemnity insurance, which can be enhanced depending on role. Something BASW could look into further if it becomes a member need.

  1. Is there anything else your profession specifically requires for clinicians/ practitioners to work in primary and community care in Wales
  2. An acknowledgment that social workers have an important role to play in primary care and a commitment by Welsh Government in ensuring this happens.

Consultation with the social work sector to fully include them in the transformation agenda.

Commitment by and involvement of Association of Directors of Social Services, Social Care Wales and Welsh Local Government Association in the transformation agenda. 

Improved training in working in other sectors at undergraduate and post-qualifying levels.   

  1. What are the barriers and challenges for your profession in developing and progressing roles in primary and community care in Wales?
  2. Cultural change -  We can’t go on doing the same things, with the prospect of an ageing population, an increase in multiple, chronic conditions and funding challenges. The demands on health and social care, and the need for innovation, along with the rise of independent social work, creates opportunities now for the NHS - and primary care in particular - to invest in social work as part of their multi-disciplinary professional team above and beyond statutory social work functions that local authorities are responsible for.

Better understanding of one another’s roles.

Funding – budgets must be combined and not controlled solely by health/GP’s. The year on year reduction in local authority budgets means social workers are working under increased pressure and have less emotional resilience to embrace the changes required to fully embrace a changed role within primary care.

Willingness to learn from good practice models/research elsewhere. Local authorities have been great and prudent innovators, since the implementation of austerity measures – learn from them.

The public perception of who does what will need work – and resources, if the public is going to have confidence in social workers operating outside of traditional roles.