GP Project

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 people’s health. The diagram below captures all these influences set out in different layers.

Influences on health (Dahlgren & Whitehead 1991)

Work Environment
  • Rights at Work
  • Changes to terms & conditions
  • Maximising income
  • Managing money and debt
  • Variable hours & zero hour’s contracts
  • Stress, health & safety at work
  • Balancing Care, Life and work responsibilities
  • Maternity and Paternity Rights
  • Discrimination
  • Sickness and Work
Relationships (Social Networks)
  • Relationships and Marriage
  • Financial help raising Children
  • Domestic Abuse
  • Separation and Housing
  • Ending a Relationship
  • Disputes over Children
  • Grandparents Rights
  • Bereavement
  • Accessing legal help and legal aid services
  • Volunteering Opportunities
  • Training
  • Choice of School/problems at School
  • Costs of education: help for parents of schoolchildren
  • Financial help for Students 16 and over in further education
  • Employment Rights when work ends
  • Benefit Advice and increasing income
  • Income Tax refunds
  • Challenging Sanctions
  • Money Advice and Debt
  • Access to Job Search
  • Financial help upon starting back at work
Housing Advice
  • Poor Housing Conditions
  • Insecure unaffordable housing
  • Harassment from Landlord
  • Problems with Energy costs and keeping warm
  • Overcrowding
  • Bedroom Tax
  • Neighbour problems
  • Homelessness
  • Housing Options
  • Financial help towards the cost of Rent
  • Adjusting to onset of long term illness/disability
  • Support around Community Care
  • Information & Advice around Health Care Services
  • Accessing Services
  • Financial help towards cost of prescriptions, glasses and dental treatment

As individuals, we can do something about some of these influences, such as eating well and not smoking but we can’t 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 can’t 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 ‘upstream’ 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

See Also:

Unit 1 Bridge Street
Clay Cross
S45 9NG
Drop-in service
Mon-Fri 10am - 2pm

0300 456 8437

You can also access advice from a number of places around North East Derbyshire and Bolsover