Glasgow health: Union demands review to GP support staff cut plans

The proposed cuts come after the Scottish Government withdrew top up funding that had enabled Glasgow to double its CLP numbers from around 30 in 2018.

CLPs are increasingly embedded in GP practices to bridge the gap between medical needs and the social determinants of health.

They play a vital support role in GP practices located within Glasgow’s most deprived neighbourhoods, by offering expert support on non-medical issues which take a toll on patients’ physical and mental health - such as housing, benefits, debt, fuel poverty, loneliness, abuse or access to food banks.

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It comes after the publication of a new report from National Records of Scotland (NRS), which showed that mortality rates are almost two times as high in the most deprived areas of Scotland compared to the least deprived areas.

Scotland’s Population Report for 2022 also found larger inequalities for some specific causes of death. 

People in the most deprived areas of Scotland were almost 16 times as likely to die from drug misuse than those in the least deprived areas in 2022 and 4.3 times as likely to die from alcohol-specific deaths.

The report considers long term life expectancy trends. In the last 40 years, overall life expectancy has improved and people are living longer. However, in the last 10 years improvements have stalled and more recently have started to reverse. 

The high level of drug-related deaths, the increase in deaths from dementia and Alzheimer’s and a slow down in the decrease in coronary heart disease deaths contribute to the stall in life expectancy improvements, NRS said. 

Death rates are almost twice as high in the most deprived areas of Scotland compared to the least deprived

Julie Ramsay, Head of Demographic Statistics at National Records of Scotland, said:  ““Some people in Scotland experience considerably worse health than others. We also see a lot of health inequality between Scotland and the rest of the UK.

“Mortality rates are almost two times as high in the most deprived areas compared to the least deprived areas. But for some specific causes of death, we see much larger inequalities. For example, people in the most deprived areas of Scotland are almost 16 times as likely to die from drug misuse than those in the least deprived areas.

“Over the last 40 years, our overall life expectancy has improved and we’re living longer than we used to. But our life expectancy is lower than the rest of the UK and many other countries in western Europe.

“In recent years, life expectancy improvements have stalled and started to reverse. Although this isn’t unique to Scotland.”

Rory Steel, GMB Scotland policy and external affairs officer, said the figures confirming the link between poverty and early death make the case to retain the CLPs unanswerable.

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He told The Herald: “Tragically, the clear link between poverty and life expectancy is no longer surprising but these statistics again demonstrate why frontline workers helping ease the impact of poverty are absolutely crucial.

“The work of CLPs, working alongside GPs to offer practical help and advice, is helping protect health and save lives in areas blighted by poverty. It could not be more important and must be protected.”

In response to the report, members of the Deep End GP group, which represents practices based in the 100 most deprived areas of Scotland, said that inequality persists within health care. 

Of the 100 Deep End practices in Scotland, 70 are based in Glasgow. 

In a statement, 'GPs at the Deep End' said: "People living in the most socio-economically disadvantaged parts of the country are more likely to live shorter lives, in poorer health, compared to people living in the most affluent areas. 

Community links workers are currently based full-time in Deep End GP surgeries to provide dedicated help to the patients using those practices (Image: PA)

“This is due to a number of factors such as higher levels of inadequate housing, food and fuel poverty, and insecure employment. 

“Poverty is associated with worse physical and mental health, and there is inadequate additional resource available for the local health services caring for more deprived communities, given the far higher levels of need that they experience."

In August, GHSCP leaders pointed the finger at Holyrood, insisting they had no guarantee that the £1.35 million they received for CLPs this year will be repeated in 2024/25.

A GCHSCP spokesperson said: “We are committed to the continuation of the community links worker programme, given the considerable benefits it brings patients.

“We expect these practices in Glasgow will continue to receive support from a Community Links Worker. 

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“However, we are only able to agree contracts based on our known income from Scottish Government at this time.

"Therefore it is anticipated some practices will see a reduction from a full time to a part-time worker come April next year. 

“We continue our discussions with Scottish Government about the funding for future years”.

A spokesman for the Scottish Government said it was up to local integration authorities to decide how best to manage their resources, but that it expects services to "continue to provide the necessary support needed". 

Commenting on the new NRS report, a GCHSCP spokesperson added: “Poverty is the key driver of poor health in any society, and it impacts on health in a myriad of ways. These figures therefore are not at all surprising, but that does not make them any less troubling. 

“There is a large and robust evidence base (international, UK and Scottish) that shows that UK Government austerity measures which have increased levels of poverty, cut the income (social security) of the poorest, and cut crucial public services that people rely on, are the main drivers of these appalling trends. 

“We need action, at all levels of government ­– but especially at UK level – to reverse them.”

Responding to the report findings on mortality rates, Drugs and Alcohol Policy Minister Elena Whitham said: “My thoughts and condolences are with all those who have lost a loved one.  

“Scotland’s communities experience health, quality of life and even life expectancy differently across our society. We will continue to work with our partners, including Public Health Scotland and National Records of Scotland, to understand what is needed at a national and regional level to support local, preventative action to drive improvements in population health and to tackle inequalities.

“We are also developing our first delivery plan for our new Dementia Strategy for Scotland and our Heart Disease Action Plan outlines the actions we are taking to minimise preventable heart disease.

“Through our £250 million National Mission on drugs, which has helped support more than 300 grassroots projects, we are doing everything within our powers to tackle drug deaths and the total Drugs and Alcohol budget has increased again to £161.6 million in 2023-24. We will also increase our focus on a whole-government approach.”