‘Everything I knew about social services was tested – and in most cases discarded’

Bringing together social workers and NHS staff was a steep but invaluable learning curve, writes Dr Chris Mimnagh

Picture credit: vege/fotolia

by Dr Chris Mimnagh

My first encounter with a social worker as a qualified GP was at a case conference. I attended despite my GP partner’s protestations, because I was invited to. When I arrived, however, everybody was surprised to see me – and didn’t really seem to know what to do with me.

Of course, I didn’t only go along because they’d been kind enough to ask. I went because, though I was new to the practice, I’d dealt with the family concerned over the previous two years in hospital posts from gynaecology to medicine, from paediatrics to A&E.

I said as much when asked to introduce myself. The response from the senior social worker coloured my view of social services for the next decade.

“It’s not about who’s the best friend of the patient – it’s about making the best decision,” the social worker said. While that is correct, I hadn’t, in my introduction, implied friendship, only that as a clinician I had a few years’ experience with the family covering the breadth of their health needs.

Back at the practice my senior partner laughed, certain now that I understood why it was foolish to attend a case conference: “They put them on at short notice, right in the middle of surgery – we’re not meant to go.”

Making relationships a priority

Fast forward 10 years. As a primary care trust director in Knowsley I found myself joining a team drawn from both the council and the NHS. I sat alongside colleagues whose careers started at the coalface of social work, whose hearts still pounded the beat of universal and targeted services and whose passion for people was boundless. My chief executive Anita Marsland always remained a social worker at heart.

For me this period was a steep learning curve. Everything I knew about social services was tested – and in most cases discarded. The insight into the pressures of the job, the constraints on powers, the failure of health and social care to get on the same side of the client or patient was the reason why Knowsley integrated the health and social care pound. In effect, working alongside the DASS in an integrated team for six years I became the medical director of social services.

What did my time in post teach me? First, that our interfaces are often too small to be meaningful. I always recall the scene in the film Babe when the little pig is told by the dogs that sheep are stupid, and by the sheep that dogs are stupid. This view is confirmed when every interaction takes place in slow, small words because sheep or dogs are clearly stupid.

It can be much the same for GP/social worker interaction. Small conversations, brief messages, all likely to arrive at inopportune moments. “I’m concerned about this child, can you assess?” is a comment that can travel in either direction.

Perhaps we should consider the need to develop relationships as an ongoing priority. Waiting until things are needed right this second is never going to generate trust or an understanding of mutual professionalism.

Second, both services are stretched; on the edge of collapse. In such circumstances the tendency will always be to reduce work to the priorities, but if these priorities are not shared more work ensues. So we need to at least gain some insight into each other’s worlds.

Right now 90% of the work of the NHS is carried out in general practice, which is barely coping with 7% of the budget. Many practices are surviving on goodwill, mistaken dedication and fatalism. Recruitment is next to impossible, with promises of an “extra 500 GPs” being too little, too late and more than offset by the exodus created by pensions, taxation and contract changes. Set against the swingeing cuts to social services the NHS has been relatively protected, but the GP/ social care interface is an interface of the disaffected and disempowered.

Finding common ground

I’ve got a couple of simple suggestions towards making things better. Start by looking to create common ground. Not via lanyard-wearing round-table discussions, but with relationships created, curiosity shown and understanding gained. Approach local GP training practices and ask them, do they want a tutorial for their registrars on social work? I bet you nobody says no. Build on that start with shared information and support.

Social prescribing is something that’s being hailed as the new messiah of self-care. Despite the naff name, which perpetuates the medical model (I prefer to think of it as social resource empowerment), here GPs are not best-placed to lead. Most councils have better networks across more diverse voluntary and third-sector groups than most GPs.

I use the hated phrase ‘best-placed’ because all too often it comes from the mouth of a pressure group seeking to load more work onto a creaking primary care system in the belief that their particular grinding axe is not getting its fair share of primary care. That said, I don’t think social services are truly best-placed either, but my strong suspicion is that a triumvirate of health, social and third-sector is the way to empower self and social care in order try to cope with the tsunami or an ageing population and static or falling budgets.

Finally, it doesn’t take a genius to realise that the NHS and social care are on the edge of a revolution. The law won’t change, but the era of the commissioning dinosaur is at an end, CCGs will merge, and our delivery will come through accountable care systems.

The single biggest way the relationship between GPs and social workers can improve is to recognise what we share in common: we are already accountable for our actions, we can be accountable for our population’s care and we will be holding each other to account.

I’m actually quite looking forward to the future now.

Chris Mimnagh is a Liverpool-based GP.  

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6 Responses to ‘Everything I knew about social services was tested – and in most cases discarded’

  1. Jason April 5, 2017 at 4:32 pm #

    That was a nice thing to read, I value your honesty in recognising the barriers that we all face. I am a practicing Social Worker, not of many years, but one thing that resonates with me was the reference to Babe. When starting as a practitioner there used to be an invite section for me to invite the GP to a case conference for children and when I completed this I was told the GP never turns up. After a few attempts I stopped doing it because the GP never turned up.

    However I agree with you that we all need to be in this together to make an informed decision for the child and their family. It is just unfortunate that GP’s are also overwhelmed by their appointments that prevents them form coming to an important, and sometimes life changing, meetings.

    We have got to get better at this but how we do it is down to our relationships which, unfortunately, is poles apart.

  2. Aurelia April 5, 2017 at 11:56 pm #

    Thank you for this; I share the hopeful future 🙂

  3. Kathy April 6, 2017 at 3:21 pm #

    Good article – great sentiments – and something I think we all know is very true. When I did my social work training some few years ago at ARU in Chelmsford they ran a series of two hour seminars for student social workers and trainee GP’s at which we debated a variety of issues such as CP, confidentiality, sharing information etc.. These were very interesting and must have been generally valued by everyone because they were well attended and additional to timetabled academic requirements. More of this sort of initiative might be a good way to start……

  4. Deborah April 6, 2017 at 7:13 pm #

    Great idea about trainee GP practices. I think I will start ringing around. We would love to be doing more actual face to face case discussions, and while we have great relations with our DNs and other health colleagues we do struggle to through the front door of the surgeries. Where we do, it is SO beneficial.

  5. Rosaline April 6, 2017 at 8:14 pm #

    A fabulous article, breaking the barriers within these relationships are essential to enable effective working together and sustainable outcomes to be achieved.

  6. Molly April 25, 2017 at 6:42 am #

    Case conferences legally have to be convened within 15 days of the decision to hold one and there has to be an independent chair and social work representative there, or the conference cannot go ahead. This dictates when the conference is held not Childrens Services deliberately trying to avoid GP’s attending. Unfortunately there is now very little flexibility of dates for meetings due to everyones stretched resources meaning multi-displinary meetings within legal timescales are becoming impossible.