A recent consultation document from the Conservative Party’s grassroots policy forum warned that some GP surgeries were stretched due to an expanding older population, with older people much more likely than others to consult their family doctors. It then asked party activists whether they agreed or disagreed with the statement that there “should be no annual limit to the number of appointments people can book to see their GP”.
The idea that such a limit could be considered led Dr Clare Gerada, chair of the Royal College of GPs, to say: “This was obviously written by someone who has never been unwell or has never met people who work in the health service.”
But do people visit their GP when they are ill, or simply because they are lonely and isolated?
Communities today have become more fragmented. Despite the numbers of ‘friends’ we accumulate on social media, time to chat with our neighbours and knowledge of when someone on our street needs our help is becoming less available. This kind of social capital has been ebbing away, leaving people lonely and isolated.
A 2010 Age UK evidence review on loneliness and isolation warned that certain groups were disproportionately affected by loneliness: the poor, the widowed, the physically isolated, people who have recently stopped driving and those with sensory impairment, while the oldest old (80+) were among the loneliest. Levels of loneliness among ethnic minority elders are generally higher than for the rest of the population.
So what has this got to do with the health service? A 2010 research report by the Mental Health Foundation, The Lonely Society, cited the work of social neuroscientists like John Cacioppo at the University of Chicago in providing evidence that “loneliness causes physiological events that wreak havoc on our health”.
“Persistent loneliness leaves a mark via stress hormones, immune function and cardiovascular function with a cumulative effect that means being lonely or not is equivalent in impact to being a smoker or non-smoker,” said the report. “Loneliness alters our behaviour, increasing our chances of indulging in risky habits such as drug-taking, and plays a role in mental disorders such as anxiety and paranoia. Loneliness is also a known factor in suicide.”
GPs and social workers working together
So instead of considering a cap on GP appointments, policymakers should be looking for a different prescription – asking GPs to work with social workers to address the problems of loneliness and isolation within local communities.
In the 1980s and 1990s, social workers worked with people in their communities to promote resilience, to empower and enable people to look not only look after themselves but also care for neighbours, friends and family.
But in the last ten or fifteen years a different way of working has emerged that is about ‘managing’ people’s care, with more focus on process and less on building relationships. In this model, social workers assess people and allocate resources, such as a care home or day centre placement or a piece of equipment.
The need for relationships over services
But people do not have relationships with services or pieces of equipment. Human beings need each other to feel life is worth living. They need someone who is interested in them, cares for them and they want to feel valued.
The government has recently been promoting the integration of health and social care services. Joining up resources is seen as a way of addressing shrinking budgets as well as providing a seamless service for people, with better outcomes. But do existing models of integration take account of a key issue – that many of the GP visits can stem from loneliness?
If we are to genuinely address this issue, GPs and social workers must work together. GPs look after small sections of the local population and typically, within that, there will be a group who have high needs. This group is usually well known, both to the GP and to social services.
Social workers in surgeries
If social workers are based alongside GPs for a part of the week, they can pool knowledge about those who are vulnerable and at risk. Their needs can be jointly assessed and planned for along with other specialists as needed. Importantly, GPs and social workers can also jointly plan for those who may become vulnerable in the future as part of their preventive role.
Currently the resources available to divert people away from hospitals largely consist of care homes and day centres – institutional care by another name. This needs to change. We need more creative, person-centred ways of supporting people in their own communities, helping them develop their own independence by building their confidence and reducing isolation and loneliness by helping them reconnect with their networks.
We need approaches that bring together people of all ages and from different ethnic backgrounds to develop inclusive communities, so that nobody feels alone or lonely. This may sound like a utopian statement but social enterprises such as Vintage Communities and Southwark Circle are doing just that.
In Hounslow we are exploring building course credits for working with communities into further education courses such as, for example, students teaching computer skills to older people, which create intergenerational relationships. The transfer of public health to local government creates real opportunities to shape places so that they create cohesive communities and reduce loneliness. These will divert resources away from the beleaguered health system.
Sherry Malik is director of children and adults at the London Borough of Hounslow