who uses welfare benefits advice services in primary care?

Health and Social Care in the Community

11

(2), 168–174

168

© 2003 Blackwell Publishing Ltd

Abstract

There is considerable interest among organisations such as primary care trusts and health action zones in commissioning welfare benefits advice services in primary healthcare settings as part of local strategies to reduce health inequalities. However, very little is known about the contribution to health of such services or about the health status of those who use them. The present study reports on a longitudinal study of the contribution to individual health of welfare benefits advice in primary care that has gathered baseline demographic and health data on 345 research subjects. The average age of the subjects was 54 years, and they were likely to be unemployed or retired. Over 85% were advised to apply for welfare benefits or to appeal against the loss of a benefit, the most common benefit being Disability Living Allowance (over 50% of all subjects). Three-quarters reported a physical disability or long-term illness that limited their daily activity, and over half reported arthritis or rheumatism. Scores on the short form 36 (SF-36) which quantify self-reported physical and psychosocial aspects of health, were much lower than population norms, indicating poorer health. The burden of illness borne by users of these services is not surprising. However, reliable data has not previously been available. It appears that primary care provides good access to advice services for people in middle and old age, but not to other groups (e.g. families with young children, substance misusers or those with mental health problems). Better data collection by advice services, wherever located, would strengthen their understanding of the needs of those whom they serve, and help them to identify under-served groups. These data could be used to support requests for continued or extended funding.

Keywords:

disability, poverty, primary care, SF-36, welfare benefits advice, welfare benefits

Accepted for publication

13 November 2002

Blackwell Science, Ltd

Who uses welfare benefits advice services in primary care?

Stephen Abbott

BA MAEcon CQSW

1

and Lindsay Hobby

BSocSci RN RM

2

1

Public Health and Primary Care Unit, School of Nursing and Midwifery, City University, Liverpool, UK and

2

Health and Community Care Research Unit, University of Liverpool, Liverpool, UK

Correspondence

Stephen AbbottPublic Health and Primary Care UnitSchool of Nursing and MidwiferyCity UniversityPhilpot StreetLondon E1 2EAUKE-mail: [email protected]

Introduction

Services which offer welfare benefits advice in primarycare have been established for over a decade (Paris &Player 1993), and the National Association of CitizensAdvice Bureaux (2001) reports about 250 such schemes.Greasley & Small (2001) have reviewed the availableliterature about such projects, which are usually succ-essful in raising substantial amounts of money forindividuals. There is currently a good deal of interest in

extending such services. For example, 39% of a randomsample of 71 primary care groups and trusts reportedsome joint working with local authorities in the area ofwelfare benefits (Wilkin

et al

. 2001).One of the rationales for situating such services in

primary care is that such a location should improveaccess for service users. Qualitative evidence suggeststhat this is indeed the case. Service users report findingit easier to access the service in a setting which is famil-iar, unstigmatising and nearer to home (Moffat

et al

.

Welfare benefits advice services use

© 2003 Blackwell Publishing Ltd, Health and Social Care in the Community

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(2), 168–174

169

1999, Emanuel & Begum 2000, Sherratt

et al

. 2000),premises may be better than those of high street services(Fleming & Golding 1997), and appointment systemsare sometimes seen to be more efficient and waitingtimes shorter (Moffat

et al

. 1999, Emanuel & Begum2000). Service users have reported various barriers tousing high street services: geographical distance, espe-cially in rural areas, lack of clarity about how to accessthe service, long waiting times, and lack of continuity inadvisers (Galvin

et al

. 2000). One service in primary carereports that two out of three of its users would not havesought help in high street services (National Associa-tion of Citizens Advice Bureaux 1999).

Primary care trusts also appreciate closer workingwith advice services, both because the advisers give abetter service to patients than National Health Service(NHS) staff do (Sherratt

et al

. 2000) and because theservice saves staff time (Fleming & Golding 1997,Coppel

et al

. 1999, Sherratt

et al

. 2000). It has been sug-gested that the service reaches people with particularneeds; for example, older people (Abbott & Hobby1999, Moffat

et al

. 1999), people with depression (Galvin

et al

. 2000) or those with complex problems (Middleton

et al

. 1993). Collaboration between NHS and advice stafffacilitates case-finding (Scully 1999, Emanuel & Begum2000, Sherratt

et al

. 2000). Evidence from all of thesestudies confirms that primary and community health-care does refer to the service, although the extent of thiscan differ sharply between practices (Fleming & Golding1997, Abbott & Hobby 1999).

A wide range of factors associated with deprivationhas been hypothesised and/or demonstrated as beingalso associated with ill-health (e.g. Marmot & Wilkinson1999, Graham 2000). These may be grouped as follows:

•

biological (e.g. poor nutrition, especially in childhood, and low birth-weight);

•

environmental (e.g. poor housing, i.e. damp and cold, polluted neighbourhoods, and greater exposure to physical and chemical hazards at work);

•

social (e.g. educational deprivation, poorer access to health care, and increased likelihood of unemployment);

•

psycho-social (e.g. worry about money, housing, work insecurity or being a victim of crime, monotonous work, and work offering no autonomy); and

•

behavioural (e.g. health-damaging behaviours such as smoking and no exercise).

Although policies to tackle many of these causes ofill-health are often population- or community-based, itis clear nevertheless that increasing the incomes ofdeprived individuals can also make a contribution. Forexample, the purchase of better food, more domestic

fuel, mobility aids and access to leisure facilities may allpromote individual health. Therefore, welfare benefitsadvice services have a contribution to make to healthimprovement and the reduction of health inequalitiesby helping deprived individuals and families to maxim-ise their income. Nevertheless, there is little evidencewhich demonstrates how interventions to reduceindividual deprivation impact on individual health(Greasley & Small 2001), or how they can thereby con-tribute to the health improvement and the reduction ofhealth inequalities (Arblaster

et al

. 1995).Indeed, there is a scarcity of data of all kinds about

such services and those whom they serve. Hobby

et al

.(1998) found that Citizens Advice Bureau (CAB) servicesin primary care typically collect few data about theirclients, and what is collected is primarily demographic,such as age, sex, employment and housing status; littleinformation about health is collected, despite thesebeing health-based services. At the same time, theprimary care services which host these services rarelysupplement health data with demographic or socio-economic information (Smeeth & Heath 1999). Thus,primary-care-based services are provided on the assump-tion that they will be accessed by suitable service users,a reasonable assumption, but one which has not beencorroborated by reliable data.

The present paper reports both demographic andhealth-related data about service users who entered anational study of such services in relation to individualhealth (Abbott & Hobby 2002). These data provide, forthe first time, information about the clients whomprimary-care-based services are reaching. The presentauthors first describe the methods used to collect dataand then the seven research sites. They then presentfindings about both the socio-economic and healthstatus of service users. A discussion follows.

Subjects and methods

Advice workers at the research sites (see below) agreedto ask all service users receiving welfare benefits advicebetween January 2000 and the end of March 2001 to givesigned consent to an interview with a researcher. Wherethis was agreed, the interviews took place shortlyafter the consultation, and were repeated after 6 and12 months wherever possible. The first interviews(which provided the data reported here) consisted of astructured interview about the subject’s health andquality of life, and the completion of the SF-36 health-related quality of life profile.

The SF-36 was chosen because it is a well-establishedinstrument (Dixon

et al

. 1994) that can be administeredby an interviewer (Farhan 1993), is able to detect lowlevels of ill health (Brazier

et al

. 1992) and includes

S. Abbott & L. Hobby

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psycho-social aspects of health, since disease statusalone does not fully reflect the burden of illness(Muldoon

et al

. 1998). In addition, it had measuredstatistically significant changes in health in a pre-vious study of welfare benefits advice (Abbott & Hobby2000).

The SF-36 comprises 36 questions, grouped intoeight health domains. These domains are as follows:

1

physical functioning: the extent to which health limits physical activity;

2

role functioning – physical: the limits which physical health puts on the range and extent of all types of work;

3

bodily pain: the severity of pain and its impact on activities;

4

self-reported general health: subjects’ rating of their own health, comparison with other people’s health and proneness to illness;

5

vitality: levels of energy and tiredness;

6

social functioning: the impact of physical health or emotional problems on normal social activities;

7

role functioning – emotional: the limits which emotional problems put on the range and extent of all types of work; and

8

mental health: degrees of nervousness/calmness, happiness/sadness (i.e. not associated with a psychiatric diagnosis).

The answers to each question are scored and a meanscore for each domain is calculated according to instruc-tions in the manual (Medical Outcomes Trust 1994).

All data were analysed using the SPSS 9 statisticalcomputer program. Research ethics committee approvalof the whole study was obtained.

Research sites

The seven research sites were as follows:

•

a CAB service situated in 28 practices, all serving a metropolitan population with significant levels of deprivation (54 clients included in the study);

•

a CAB service situated in three practices serving a deprived population in a large coastal town (16 clients);

•

a CAB service situated in three practices serving prosperous country town and village communities (31 clients);

•

a CAB service in six practices serving a mainly rural community, with some commuters, living in small towns and villages (26 clients);

•

a local, county-council-run service situated in two practices serving very deprived former mining communities (133 clients);

•

a joint CAB and city council service situated in three practices serving a deprived urban community (68 clients); and

•

a CAB service in 14 practices serving a very deprived urban community with a significant ethnic minorities population (17 clients).

The wide range of subject numbers at each sitereflects the difficulties in recruiting in some localities.The establishment of links between advisers andresearchers was delayed in one site because of changesin advice service manager, and in another, because theservice was expanding rapidly, placing a great strainon the organisation’s management. In addition, oneresearcher left after a few months and had to bereplaced, which meant that some potential subjectsfrom two sites who had agreed to be interviewed werenot questioned.

Results

Three hundred and forty-five people were recruited tothe present study and took part in a structured inter-view. Out of these individuals, 139 (40.3%) attendedservices in metropolitan areas, and 206 (59.7%) in townsor villages. Half of all subjects were aged between 45and 64 years (Table 1). The average age was 54.2 yearsand the age range was 19–92 years. Just over half werewomen. Only 12% were in work: over three-quarterswere unemployed or retired. Forty-five per cent wereowner occupiers and half lived in rented accommoda-tion. About one-third lived with children, and one-fifthlived alone. Almost all subjects (97%) described them-selves as white.

The participants were asked how and why they hadaccessed the service. One-third (

n

= 114) had heardabout their service from their general practitioner (GP),and one-fifth (

n

= 74) from a friend or relative. Forty(11.6%) said that they had found out from other mem-bers of the primary health care team, and the samenumber from the advice service itself. Ninety per cent(

n

= 312) went seeking welfare benefits advice. Aboutone-third (

n

= 113, 32.8%) had previously used similarservices elsewhere. As Table 2 shows, prior to advice,one-third were already receiving Council Tax Benefit,and about one-quarter were receiving Income Support,Incapacity Benefit and Housing Benefit. Only one-fifthwere receiving no benefits at all prior to advice.

Eighty-five per cent received welfare benefits advice(Table 3), and in over half of all cases, this advice con-cerned applying for Disability Living Allowance orappealing against the loss of this benefit. Seventy-oneper cent received advice on making a new claim and14% on how to appeal against the loss of a benefit.



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Over one-third (

n

= 125) saw an adviser within2 days of requesting an appointment, and 40% (

n

= 142)between 3 and 7 days. Forty-four per cent (

n

= 153)of consultations lasted up to half an hour, and 39%(

n

= 133) lasted between half an hour and one hour.Three quarters of subjects reported feeling less anxiousand/or worried after the consultation. Almost all (

n

=337, 97.7%) followed the advisor’s suggestions.

Table 4 records health data. Three-quarters of thesubjects reported a long-standing illness that limited

daily activity and half reported a physical disability.Over half reported arthritis and/or rheumatism, one-third reported high blood pressure, and over one-quarterreported asthma, sensory impairment or heart trouble/

Table 1 Demographic information (n = 345)

Variable Number Percentage

Sexmale 160 46.4female 185 53.6

Age (years)15–24 13 3.825–34 31 9.035–44 46 13.345–54 79 22.955–64 93 27.065–74 50 14.5≥ 75 33 9.6

Employment:employed 42 12.2unemployed 150 43.5retired 114 33.0long-term sick 29 8.4other 10 2.9

Housingowner occupier 155 44.9rented (social housing) 139 40.3rented (private) 32 9.3other 19 5.5

Household compositionsingle 74 21.4couple 130 37.7single with children 39 11.3couple with children 76 22.0other 26 7.5

Table 2 Benefits already received (n = 345)

Benefit Number Percentage

Council Tax Benefit 114 33.0Incapacity Benefit 89 25.8Housing Benefit 87 25.2Income Support 86 24.9Disability Living Allowance 59 17.1Industrial Injuries Benefit 15 4.3Attendance Allowance 14 4.1Other 117 33.9No benefit 75 21.7

Table 3 Advice received (n = 345)

Advice Number Percentage

What advice did they give you?About income 294 85.2New benefit 245 71.0Appeal against loss of benefit 49 14.2Debt re-scheduling 15 4.3Other 36 10.4

Benefits claimedDisability Living Allowance 182 52.8Attendance Allowance 53 15.4Income Support 53 15.4Council Tax Benefit 38 11.0Incapacity Benefit 35 10.1Housing Benefit 25 7.2Industrial Injuries Benefit 8 2.3Other 32 9.3

Table 4 Health of subjects at baseline (n = 345)*

Variable Number Percentage

Health conditions reported:arthritis/rheumatism 185 53.6high blood pressure 114 33.0asthma 98 28.4sensory impairment 90 26.1heart trouble/angina 89 25.8diabetes 35 10.1stroke 24 7.0physical disability 172 49.9mental health problems 40 11.6any of the above 312 90.4

Number of these conditions per subject: 0 33 9.6 1 74 21.4 2 102 29.6 3 72 20.9 4 40 11.6

≥ 5 24 6.9

Long-standing illness that limits daily activity?

259 75.1

Neither health condition nor long-standing illness

25 7.2

* These data give a general indication of how the subjects perceived their own health. The subjects’ self-diagnoses would not necessarily be confirmed by a clinical examination. Furthermore, categories are not mutually exclusive. Subjects will have varied in how they chose to supply information (e.g. to report heart trouble as well as a stroke or high blood pressure). There will also be inconsistencies in how people defined long-term limiting illness, and whether or not ‘physical disability’ excludes conditions which have been already reported.


172


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angina. Two-thirds of the participants reported two ormore of these conditions. Only one in 10 reported none.It is important to note that these self-reports should notbe taken as clinically accurate, nor are they mutuallyexclusive; for example, some who had a stroke or highblood pressure may also have classified this as hearttrouble, while others did not. Similarly, some who hadreported arthritis or asthma, for example, also answered‘yes’ to the question about long-standing illnesses and/or physical disability, while others did not.

Over one-fifth described themselves as caring forother people, over half of whom (

n

= 44 out of 79, 55.7%)said that a recent increase in the burden of care hadaffected their own health.

Table 5 compares the SF-36 scores of the present sub-jects with those of a representative population sample(higher scores represent better health). These findingsconfirm that people using welfare benefit advice serv-ices in primary care are substantially less well than anormal population.

It cannot be assumed that those agreeing to take partin the present study are typical of all those using suchservices. It is reasonable to assume that certain groupsare under-represented; for example, those who felt tooill or frail to participate, or those whose experienceof their first consultation was negative. Therefore, thepresent authors attempted to compare those using theprimary care-based services as a whole with thoseparticipating in this research. However, this provedextremely difficult because services routinely collect so fewdata. Indeed, no data at all was obtained from two sites.

In four out of the five sites for which data were pro-vided, those interviewed were older than those usingthe service as a whole, and therefore, more likely to beretired. In all of the four sites where the gender profilecould be compared, research subjects were more likelyto be male than service users in general. It was not

possible to compare health profiles owing to lack ofrelevant routinely collected data.

The authors also attempted to obtain data whichwould enable them to compare those using each adviceservice in primary care with those using a comparableadvice service elsewhere in the same town or district.Once again, it proved almost impossible to obtainadequate data. Where the authors were successful, noconsistent differences were apparent other than age:services situated in primary care appear to attract olderclients. Data deficits meant that it was not possible tocompare health status.

Discussion

The poor health of those using these services is clearlyshown not only by the self-report of single or multiplehealth problems, but also by the SF-36 scores, and bythe high numbers of clients either already receivingor applying for disability living allowance. Such poorhealth is not surprising, particularly to welfare benefitsadvisors working in primary care who are well aware ofsuch health problems, but who generally lack systemsand/or time to record relevant data.

It is a limitation of the present study that, because ofdifferential recruitment rates, this sample is not represent-ative: former mining communities are over-represented,and deprived inner-city and prosperous communitiesare under-represented. However, separate analyses ofthe profile of service users at each of the sites showedprofiles broadly similar to the aggregate profile ofservice users described here, suggesting that suchservices are likely to attract similar clients whatevertheir location.

The under-representation of prosperous communi-ties might be assumed to be relatively unimportantsince advice services are more likely to be set up indeprived areas. However, the majority of deprived peo-ple do not live in the most deprived communities ( Joshi

et al

. 2000), and if services are targeted at areas of great-est need alone, such people will not have access to suchservices. Some of the services taking part in the studytarget older people by writing to patients selected fromGPs’ lists by age. In practices where the registered popu-lation is generally deprived, this is probably the easiestmethod of targeting and could be undertaken by a servicewherever it was located. However, in practices whereboth affluent and deprived patients are registered, itwould be difficult to target the less well-off in this waybecause primary care generally does not record socio-economic data which could distinguish those in need.

The issue of data collection by advice services is animportant one. Although many services do collect dataabout the value of benefits received as a result of advice,

Table 5 Mean SF-36 scores for research subjects at baseline compared with population norms (NB higher scores represent better health)

Health domain

Present study(age range =19–92 years)

West Glamorgan*(age range = 20–89 years)

Physical functioning 35.8 76.2Role functioning – physical 22.8 72.5Bodily pain 35.7 70.9General health 34.8 66.6Vitality 31.3 58.4Social functioning 44.6 80.6Role functioning – emotional 40.9 82.8Mental health 51.7 75.3

* Source: Garratt et al. (1993).



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such data are not always reported clearly (Hobby

et al

.1998). General practitioners and others working inprimary care who are sceptical about the importanceof placing such services in primary care (Chaggar 1993,Abbott & Hobby 1999) might be persuaded to changetheir minds if they were made aware that, for example,over half of the patients likely to use the service wereeligible for Disability Benefit, and therefore, that adviceservices can help to reduce health and social inequali-ties locally.

All advice services, whether in primary care or else-where, should also consider collecting some informa-tion about health from their clients. It would clearly beabsurd to expect advice workers to administer the SF-36as a matter of routine. However, it would not be unre-alistic to expect them to include basic questions abouthealth from the census (Office of National Statistics2001), i.e.:

•

Over the past 12 months, would you say your health has on the whole been good, fairly good or not good?

•

Do you have any long-term illness, health problem or disability which limits your daily activities or the work you can do?

By asking these questions of all clients, whatever thebenefit being claimed, and by collating and analysingthe answers, advice services would increase theirknowledge base. Primary-care-based services wouldbe in a position to demonstrate that they provide animportant service to those with chronic illnesses inmiddle and old age, while advice services located else-where would be better able to identify other populationgroups who might benefit from easier access to adviceservices; for example, families with young children,substance misusers, people with mental health prob-lems, HIV, and other specific diagnoses. It appears fromthe present data that members of these groups are notnecessarily heavy users of GP-practice-based services,and they may or may not use existing high street serv-ices instead. Without good-quality information aboutclients and their needs, welfare benefits advice serviceswill find it harder to argue for funding to develop andsustain more responsive services, services which havean important role to play in local strategies to reducehealth and social inequalities.

Acknowledgements

The research on which this paper is based was commis-sioned by a consortium of Citizens Advice Bureaux,using National Lotteries Charities Board funding. Wewould like to thank Mick Bond, Catherine O’Sullivanand two anonymous reviewers for their helpful com-ments on earlier versions of this paper.

References

Abbott S. & Hobby L. (1999)

An Evaluation of the Health andAdvice Project: Its Impact on the Health of Those Using the Serv-ice

. Health and Community Care Research Unit. Universityof Liverpool, Liverpool.

Abbott S. & Hobby L. (2000) Welfare benefits advice inprimary care: evidence of improvements in health.

PublicHealth

114

, 324–327.Abbott S. & Hobby L. (2002)

What Is the Impact on IndividualHealth of Services in Primary Health Care Settings Which OfferWelfare Benefits Advice?

Health and Community CareResearch Unit. University of Liverpool, Liverpool.

Arblaster L., Entwistle V., Lambert M., Forster M., Sheldon T.& Watt I. (1995)

Review of the Research on the Effectiveness ofHealth Service Interventions to Reduce Variations in Health

.NHS Centre for Reviews and Dissemination, York.

Brazier J.E., Harper R., Jones N.M.B., O’Cathain A., Thomas K.J.,Usherwood T. & Westlake L. (1992) Validating the SF-36health survey questionnaire: new outcome measure forprimary care.

British Medical Journal

305

, 160–164.Chaggar J.S. (1993) Citizens’ Advice in general practice. A

burden GPs could do without.


307

, 261.Coppel D.H., Packham C.J. & Varnam M.A. (1999) Providing

welfare rights advice in primary care.

Public Health

113

, 131–135.

Dixon P., Heaton J., Long A. & Warburton A. (1994) Reviewingand applying the SF-36.

Outcomes Briefing

4

, 3–25.Emanuel J. & Begum S. (2000)

What Do You Advise, Doc? ACitizens Advice Bureau in Primary Care in the West Midlands

.University of Manchester Faculty of Education, Manchester.

Farhan M. (1993) Using SF-36.

Audit Trends

1

(4), 153–156.Fleming B. & Golding L. (1997)

Evaluation of 4 CAT-Funded Citi-zens’ Advice Bureaux Units.

Soundings Research, Birmingham.Galvin K., Sharples A. & Jackson D. (2000) Citizens advice

bureaux in general practice: an illuminative evaluation.

Health and Social Care in the Community

8

, 277–282.Garratt A.M., Ruta D.A., Abdall M.I., Buckingham J.K. &

Russell I.T. (1993) The SF-36 health survey questionnaire: anoutcome measure suitable for routine use within the NHS.


306

, 1440–1444.Graham H. (Ed.) (2000)

Understanding Health Inequalities’

.Open University Press, Buckingham.

Greasley P. & Small N. (2001)

Welfare Advice in Primary Care

.University of Bradford, School of Health Studies, Bradford.

Hobby L., Emanuel J. & Abbott S. (1998)

Citizens’ AdviceBureaux in Primary Care in England and Wales: A Review ofAvailable Information

. Health and Community Care ResearchUnit. University of Liverpool, Liverpool.

Joshi H., Wiggins R.D., Bartley M., Mitchell R., Gleave S. &Lynch K. (2000) Putting health inequalities on the map: doeswhere you live matter, and why? In: H. Graham (Ed.)

Under-standing Health Inequalities, pp. 143–155. Open UniversityPress, Buckingham.

Marmot M. & Wilkinson R.G. (Eds) (1999) Social Determinantsof Health. Oxford University Press, Oxford.

Medical Outcomes Trust (1994) SF-36 Health Survey. Scoringmanual for English language. Adaptations: Australia/NewZealand, Canada, United Kingdom. Medical Outcomes Trust,Boston, MA.

Middleton J., Maunder B., Little V., Bentley D., Spearey H.,Vanes J., Norman A., Lucas G. & Bone B. (1993) CitizensAdvice in general practice. British Medical Journal 107, 604.

Moffat S., White M., Stacey R., Hudson E. & Downey D. (1999)‘If we had not got referred and got the advice, I don’t know where


174 © 2003 Blackwell Publishing Ltd, Health and Social Care in the Community 11(2), 168–174

we’d be, it doesn’t bear thinking about.’ The Impact of WelfareAdvice Provided in General Practice: A Qualitative Study.Department of Epidemiology and Public Health, andDepartment of Primary Health Care, University of New-castle upon Tyne, Newcastle upon Tyne.

Muldoon M.F., Barger S.D., Flory J.D. & Manuck S.B. (1998)What are quality of life measurements measuring? BritishMedical Journal 316, 542–545.

National Association of Citizens Advice Bureaux (1999)Prescribing Advice. National Association of Citizens AdviceBureaux, London.

National Association of Citizens Advice Bureaux (2001)Annual Report, 2000/1. National Association of CitizensAdvice Bureaux, London.

Office of National Statistics (2001) Household census form.[WWW document]. URL www.statistics/gov./uk/census2001

Paris J.A.G. & Player D. (1993) Citizens’ Advice in generalpractice. British Medical Journal 306, 1518–1520.

Scully T. (1999) Welfare Rights and Primary Health Care.Sheffield Advice Centres Group, Sheffield.

Sherratt M., Jones K. & Middleton P. (2000) A citizens adviceservice in primary care: improving patient access tobenefits. Primary Health Care Research and Development 1,139–146.

Smeeth L. & Heath I. (1999) Tackling health inequalities inprimary care. Recording socio-economic data in primarycare is essential. British Medical Journal 318, 1020–1021.

Wilkin D., Gillam S. & Coleman A. (2001) The National TrackerSurvey of Primary Care Groups and Trusts 2000/2001: Modern-ising the NHS? National Primary Care Research and Devel-opment Centre, Manchester, and King’s Fund Publishing,London.

who uses welfare benefits advice services in primary care?

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