Table 1.
Description of the Glasgow Deep End Links Worker Program Using the TIDieR Framework12
| Name | The Glasgow Deep End Links Worker Program |
|---|---|
| Purpose | The development of the Glasgow Deep End LWP drew on the theory of community-oriented primary care13 and was based on a report by GPs working in the Deep End.14 Patients attending general practices in deprived areas commonly have multiple problems, many of which are not amenable to medical intervention. Community organizations offer a wide range of resources, but people in deprived areas with multiple health and social problems can find it hard to access them. Closer links between general practices and community organizations, and support to access to available community resources, could mitigate the effects of deprivation. Links between general practices and community organizations could be enhanced by adding a nonmedical CLP to the practice team. CLPs would operate from the general practice, forge relationships between general practices and community organizations, and support patients to access the nonmedical services and support on offer. CLPs would act as a catalyst to hope and self-determination, using the strong relationships with patients that exist in general practice. If patients with complex needs feel supported, they would be more likely to respond to information on ways to improve their health. |
| Resources | A practice-attached CLP with a previous working background in community development. The CLPs all had previous experience of working with individuals and community organizations and had skills in identifying assets, needs, opportunities, rights, and responsibilities. Management support for the program was provided by the CLPs’ employing organization, the Scottish Alliance for Health and Social Care (Scotland). Support included (1) an experienced program director, overseeing all aspects of the program including the production of detailed records of learninga; (2) a community links manager, with experience in community development and staff management, responsible for establishing protocols and polices for CLP work and line managing the CLPs; (3) a learning and evaluation officer, responsible for establishing local protocols for program monitoring (independent of the evaluation conducted by the research team); (4) administrative staff; and (5) a clinical lead. A practice development fund (GBP £35,000) to spend on activities to help each practice develop the new LWP approach. The fund was used mainly to “buy time” away from clinical care to focus on the LWP. The A Local Information System for Scotland (ALISS) website,b which allows individuals and community organizations to make real-time lists of sources of support searchable by locality. |
| Procedures | CLPs made links between practices and community organizations in the local area (eg, walking groups, debt management support, welfare rights, drug and alcohol management support, lunch clubs, befriending schemes, crafting clubs, bereavement support). Practice staff used time away from clinical care to set up systems and learn more about services and support available in community organizations. Each practice devised its own system for GPs and PNs to identify and refer patients who would benefit from help from a CLP who would link them to community-based resources. The system was devised jointly by clinical staff and CLPs and was customized for each practice. The choice of which patients to refer to the CLP was left open by practices but was based mainly on the presence of social problems that exacerbated long-term health problems. CLPs met patients. CLPs elicited patients’ main needs and worked flexibly, making links with community organizations for patients and, if necessary, supporting patients to attend the organizations’ services. Services depended on patients’ needs, their enthusiasm to engage, and the availability of local services accessible to patients. CLPs met together weekly with a manager to share and discuss experiences and problem solve collectively. |
| Providers | GPs and PNs referred patients who might benefit to CLPs. CLPs saw patients and provided support to link patients to existing community organizations. |
| How | All contacts were one-to-one and usually face-to-face, although some telephone contacts could occur. |
| Where | CLP contacts with patients were usually in the practice, although some home visits could occur, and the CLPs could accompany patients to support their contact with a community organization. |
| When and how much | CLPs and patients could meet as many times, and when, they thought necessary. |
| Tailoring | The intervention was very flexible and dependent on patient needs, patient wants, and professionals’ judgments as to what help was needed. |
| Modifications | The intervention was not modified during the research. |
| How well | Given the flexibility of the intervention, we did not assess fidelity. |
CLP = community-links practitioner; GBP = Great Britain pound sterling; GP = general practitioner; LWP = Links Worker Programme; PN = practice nurse; TIDieR = Template for Intervention, Description, and Replication.