1. Citizens Advice in GP Surgeries:
process and outcomes in Derbyshire
Julie Hirst
Public Health Specialist
NHS Derbyshire County
Benefits and Health Event, Wolverhampton
Friday 29th June 2012

2. Derbyshire

3. Derbyshire County Profile
• Population of 750,000
• Mainly rural county with diverse
communities, e.g.
• Ex-coalfield communities in Bolsover &
North East
• Chesterfield: largest town of 100,000
• Large part of Peak District National Park
• Tourist destinations of Bakewell and
Buxton

4. Political landscape
• Two tier local government system
• County Council turned Conservative in 2009,
following 28 years’ of Labour control
• Mixed political landscape at district and borough
level
• Public Health directorate will sit in the Policy
directorate of DCC
• DPH will be managed by strategic director

5. Health Profile
• Pretty much average for England
• Life expectancy similar to England but 7.6 years lower
for men and 5.4 years lower for women in the most
deprived areas of Derbyshire than in the least deprived
areas
• Estimated levels of adult obesity are worse than the
England average. Rates of road injuries and deaths and
hospital stays for alcohol related harm are higher than
average

6. Citizens Advice in GP Surgeries
• Paris & Player paper BMJ 1993
• Piloted in Hayfield in 1995
• CAB in all 16 surgeries of High Peak and Dales PCT
(pop = 106,000) by 2004
• Derbyshire County PCT emerged in 2006 – project
saved from extinction by DPH
• CH funding to roll out between 2008-10
• Since 2010/11 CAB in 90/96 GP surgeries

7. Delivery
• Commission standardised weekly service
from 5 local Citizens Advice Bureaux
• Paid advisors work from surgery using lap
top and mobile phone
• Surgeries make appointments
• Open referral system
• Paid quarterly in advance
• Annual reports

8. Outputs 2011/12
• Clients seen 5,957
• Contacts 17,138
• Enquiries 29,673
• Financial gains £7,698,310
• Debt managed £8,138,401
• Cost per client £131
• Cost per contact £45
• Cost per enquiry £26

9. Costs and Gains
•Cost to commissioners = £767,377
•Every £1 invested generates £11 for clients
and the same £1 helps them to manage
£10.60 of their debt.

10. Impact on lives
• Collection of case studies which illustrate the
complexity and enormity of clients’ problems, the
skilled and detailed work that CAB provides and
its impact on clients’ lives.
• Almost certainly saves money ‘downstream’
• But does it improve health????

11. ‘Welfare advice in primary care: A qualitative study of
service user and staff perceptions’ (Burrows et al 2011
BJGP)
• Popular with patients and staff
• Anonymity of healthcare setting valued
• Accessible: geographically and physically
• Appointments system preferred
• Continuity of CAB staff valued by patients
• Valued resource for health staff to refer to
• Saves GP time
• Variation of CAB integration into practice

12. ‘Assessing the health benefits of advice services:
using systematic review and logic model methods to
explore complex pathways’ (Allmark et al, in press)
• A plausible case for CAB advice to improve health based
on a causal chain can be made.
• However, it very difficult to show direct cause and effect
between Citizens Advice and improved health. The
determinants of health are so complex and the benefits
accrued from a CAB referral are likely to be limited
and/or highly variable in the context of all the other
influences on people’s health and lives.

13. Logic model method

14. Thank you.