Whole Family Support Through General Practice: child rights and wellbeing impact assessment

Child Rights and Wellbeing Impact Assessment Template

1. Brief Summary

Type of proposal:

Decision of a strategic nature relating to the rights and wellbeing of children

Name the proposal and describe its overall aims and intended purpose.

Key terms and definitions:

What is Prevention - Prevention in public health is about keeping people healthy and avoiding the risk of poor health, illness, injury, and early death.

A Public Health Approach to Prevention - Public health recognises three types of prevention as central to addressing poor outcomes.

• Primary prevention is action that tries to stop problems happening.

This can be either through actions at a population level that reduce risks or those that address the cause of the problem.

• Secondary prevention is action which focuses on early detection of a problem to:

support early intervention and treatment

reduce the level of harm

• Tertiary prevention is action that attempts to minimise the harm of a problem through careful management.

Most preventative action focuses on finding people with health problems and helping people before the problem gets worse.

This does not stop people from having the problem.

Only primary prevention tries to stop the problems from happening.

“Whole Family Support through General Practice”

The Scottish Government General Practice Policy Division (GPPD) in the Primary Care Directorate (PCD) secured funding from the Scottish Government’s Whole Family Wellbeing Fund to run a time-limited project up to 2025/26. To secure the funding, PCD developed a high-level outline which set out the purpose, aims and principles of a new project based in general practices. Its aim was to capitalise on the unique role of general practice as the main provider of primary healthcare, and as a gateway to secondary care and other community-based health services.

Most people will contact their GP practice at least once in any given year and they are able to do so directly without being referred by another service. The ambition for the project was to use the unique opportunities general practices have to make the most of encounters with families to help address, not only known health issues, but also other challenges in their life circumstances and general wellbeing which could impact on the health of children or caregivers in the future. The intention was to utilise family interactions with the practice as opportunities to understand the families’ needs better and then connect them with a range of local supports and services, as well as helping the practice to provide the children and families with better healthcare. This would support a move from crisis intervention to a public health approach to prevention (definitions noted above). The project would also have to take account of new GIRFE (Getting it right for everyone) principles which build on GIRFEC (Getting it right for every child).

PCD approached Glasgow City Health and Social Care Partnership (GCHSCP) to develop a project proposal in line with the aims described above for a small-scale test of change. PCD decided to highly target the investment in Glasgow City due to:

• the scale and time-limited nature of the funding (spreading the funding more widely would have constrained the potential to achieve positive results).
• the need to test a new approach to targeted general practice work on child poverty through general practice;
• the very high levels of blanket deprivation and families living in poverty in Glasgow. (Around 80 of Scotland’s 100 ‘Deep End’ practices (those whose patient list has the highest percentage of patients living in Scotland’s 15% most deprived SIMD data zones) are in Glasgow out of a total of more than 900 practices in Scotland.

The model developed by GCHSCP and accepted by GPPD evolved into the “Whole Family Support through General Practice” project (WFSGP). The HSCP developed that model in partnership with the local statutory and voluntary sector partners, with time built into the process for community engagement, which included ensuring the views of the children and families were represented.

GPPD were not responsible for the process of developing the model, nor are we responsible for delivery, so these are not covered in detail in this CRWIA, although we have included some information below about the process, including practice recruitment.

If an evaluation of WFSGP shows that the model which is being tested by GCHSCP is effective and funding is available in future years, the Scottish Government may consider the extension of WFSGP to a larger number of practices or to other areas of Scotland.

What the HSCP project involves

The project is being delivered within a sample of ‘Deep End’ practices with high levels of poverty and, therefore, health inequalities. Importantly, the approach being tested requires the creation of additional, dedicated staff capacity (new Family Wellbeing Workers) so the budget determined that the project has to take place in a sample of eligible practices in the city to have any impact.

The HSCP ran an open and transparent process for recruiting Deep End practices. It ran two briefing sessions, for all Deep End practices in Glasgow, which GPs and/or practice managers could attend and sent out a briefing paper to all of the practices asking them to express their interest in participating in WFSGP. Once they received notes of interest, they then used the following principles to narrow down which practices would be invited to take part –

• Is it within the 30 most deprived Deep End practices based on key data*
• A geographical spread of practices across the city
• Does the practice support GP cluster working (area-based clusters, a group of closely located practices working together to improve streamlined working, are core to GP Quality Improvement) as running WFSGP in a group of practices in a specific locality of the city maximises learning and improvement.
• Fit with Multi-member wards priority areas for Community Planning (Glasgow city council have community planning priorities, and the practices have to be able to show the work will support those priorities across localities).

*The data the HSCP used included – Pregnancy rates; children aged 0-4; teenage pregnancy rates. The HSCP and SG were also keen that the sample include practices with a high proportion of BME families because of the high diversity of Glasgow. Glasgow HSCP also considered practice size and practice population age. From this, 12 practices were invited to participate and all 12 accepted.

As noted above, WFSGP will involve new Family Wellbeing Workers working alongside the existing general practice multi-disciplinary team (MDT) and provide families and children in particular, with opportunities that will support their growth and wellbeing. This funding will, for the first time, create the conditions for participating Deep End practices to take a two-pronged approach to maximise the role of general practice in supporting families who are in/at risk of poverty and poor health outcomes:

• One is through making every contact count, so that consultations with families do not just address the clinical issues presented, but are the starting point for social, psychological and economic support.
• And secondly, through outreach work with families on practice lists who are not using or under-using primary care to ensure the right type of support for them is quickly activated. Outreach is critical as many who need care and support do not know how to or cannot effectively access services.

Why general practice?

General practice has unique reach and power to effect change as the first port of call for health care and with over 920 GP settings embedded in Scotland’s communities, close to people’s homes. Over any year, almost everyone (who is registered with a GP) will contact their general practice at least once, and families with young children are often regular users of general practice and primary and community care services (including midwifery and health visitors).

This also offers the service to everyone on the practice list of participating practices and therefore reducing stigma in seeking support.

The Scottish Government’s second Tackling Child Poverty Delivery Plan - Best Start, Bright Futures - set out a commitment to work collaboratively with partners to ensure that the child poverty support system works for the people who need it most. 

The Scottish Government’s approach to Public Service Reform sets out an ambition for people’s experience of services to be efficient, high quality and effective for all, with a focus on early intervention, positive relationships and partnership working to meet needs identified by the people of Scotland. Core to this approach is prioritising prevention, having services shaped around what matters to people and communities, and removing barriers to holistic support.

Who will it affect?

The Whole Family Support through General Practice is intended to support families experiencing or at risk of child poverty. It is likely to affect the six priority family types at greatest risk of experiencing child poverty:

• lone parent families
• minority ethnic families
• families with a disabled adult or child
• families with a younger mother (under 25)
• families with a child under one
• larger families (three or more children)

The policy aims to enable these families to access services they may not have otherwise, providing holistic support and with the aim of lifting them out of poverty over the long-term.

Outcomes for the HSCP project

This project is a new project with funding in 2024/25 and 2025/26.

• General practice MDTs will be better enabled to work with teams from other statutory and third sector services to plan and provide wraparound support for families in/at risk of poverty, trauma and exclusion.
• Clearer identification and proactive engagement with families within Deep End practices that can benefit from early support, provide and test earlier intervention responses.
• Year 1 of the grant will pilot - and create the ongoing conditions and capacity for the creation and deployment of a new Family Wellbeing Worker role - a model of wraparound and proactive whole family support and early intervention support which is rooted in general practice.
• The funding enables the beginnings of transformation of how families are supported, by working towards creating the conditions for universal, holistic, services which offer people the help they need, where and when they need it.
• Working towards children and families in selected Deep End practices experiencing Getting It Right For Every Child – GIRFEC- and Getting It Right For Everyone - GIRFE-based health and care services that meet their whole family needs - at the right time - with improved health wellbeing outcomes.

Start date of proposal’s development: June 2022

Start date of CRWIA process: 09.10.24

2. With reference given to the requirements of the UNCRC (Incorporation) (Scotland) Act 2024, which aspects of the proposal are relevant to/impact upon children’s rights?

The Whole Family Support through General Practice has direct and indirect impacts on children’s rights.

Article 2- Non discrimination

Article 3 – Best interests of the Child

Article 5 – Parental guidance and a child’s evolving capabilities

Article 6 – Life, survival and development

Article 12 – Respect for the views of the child

Article 13 – Freedom of expression

Article 16 – Right to Privacy

Article 18 – Parental responsibilities and state assistance

Article 19 – Protection form violence, abuse and neglect

Article 23 – Children with a disability

Article 24 – Health and health services

Article 26 – Social security

Article 27 – Adequate standard of living

Article 31 – Leisure, play and culture

Having the project based in GP practices and in partnership with the HSCP will have positive impacts on Article 24 - Health and health services. Benefits will especially stem from the additional, new staff capacity, and from staff making the most of contact with families as opportunities to proactively work with them (including children within those families) on what matters, to them, and what their needs are. This enables improved cross-agency partnership working. Families and children with unmet needs will be able to work with the MDTs within the GP practice which includes health professionals and staff who provide support for socio-economic challenges that the family is facing which contribute to poorer health and wellbeing. Being able to build trusting and holistic relationships with professionals will support children and families, who may otherwise be isolated or lack trust in services, to be more involved with decisions and actions related to their health and wellbeing with the aim of improving engagement with services. This will support children’s access to appropriate health services in a timely manner with a view to improving the overall health of children accessing the service.

As the service is open to all who are registered with the participating GP practices, this service will have a positive impact on Article 2 – Non-Discrimination. In addition, general practice is already required to provide care in a way that is non-discriminatory.

The service will provide support and guidance through meaningful conversations with all family members and onward referrals to agreed services. In relation to children’s changing needs, the service will be open for families to return if and when things change or if they require further support. This will have a positive impact on Article 5 – Parental Guidance and a child’s evolving capabilities.

The service will be able to support families to access community groups and other statutory and voluntary services that help them to meet their needs. The HSCP has earmarked a pot of small grant funding that local charities can apply for, to provide complementary provisions or activities which will have a positive impact on Article 31- Leisure, play and culture. This communities fund will be open to local organisations that will support children’s involvement in local groups and activities.

The collaborative working within the MDTs at the GP practices includes welfare advisors which will have a positive impact on Article 26 - Social Security and Article 27 - Adequate standard of living.

The service is inclusive for families registered in the participating practices and personal plans will be made with families to support children to reach their full potential, having a positive impact on Article 23 - Children with a disability. We know that families where a child has a disability are more likely to experience poverty and inequality. Children with disabilities will have the opportunity to seek positive activities that are inclusive to their needs due to the multi-agency and holistic approach. Families will also be able to access appropriate support whether it be financial (e.g. support with benefits applications) or emotional (e.g. making sure carers receive the support they need).

The Family Wellbeing Worker, when working with families, will have the best interests of the child at the forefront from the start and support will be based on those best interests. This will have a positive impact on Article 3- Best interests of the child.

Through meaningful conversations and including children from the start of the interactions, the project will also likely have an indirect impact on a range of other rights.

Family wellbeing workers will support parents and guardians to access further services if needed e.g. Advocacy or welfare rights resulting in an indirect impact on Article 18 – parental responsibilities and state assistance. The project will encourage and support families to engage with health and other services which will help parents to access state assistance and strengthen their understanding of their related responsibilities for the children they care for.

Through interventions and additional support there will likely be an indirect positive impact on Article 6 – Life, survival and development. The Wellbeing worker and other members of the MDT will be building relationships and supporting families to access activities, services and support that will have that wider positive impact on the child/children and their development. We know that children born into poverty have poorer health outcomes as adults and are more likely to experience ACES (Adverse Childhood Experiences). The gaps in life expectancy and healthy life expectancy based on socio-economic status remain stubborn in Scotland.

As noted above, families, including children will be at the heart of the relationship and hearing from children about what they would like and how they are feeling will have a positive indirect impact on Article 12 Respect for the views of the child and Article 13 Freedom of expression.

As staff will be working with children and their families, they will receive appropriate training to support children’s rights in regard to Article 19 - Protection from violence, abuse and neglect. The project will help as it will support parents/caregivers to understand and to meet their own and their children’s health needs. This will include connecting families to wider services and resources to help them with social challenges which can contribute to neglect (e.g. parental substance use, housing, poor literacy). The practices can also connect to services which deal with domestic abuse as part of the HSCP’s delivery model.

Article 16 – Right to Privacy will be respected, there are appropriate data sharing agreements in place and conversations/support will be kept confidential (the caveat around this is if a risk is identified, staff have a duty of care to report). Families (including children within those families) have a choice to participate or not and they can leave the service at any time. The responsibility for ensuring privacy and GDPR compliance sits with the HSCP who have in place the necessary Information Governance, following a full assessment of IG/privacy issues. GP practices also have strict rules in place around GDPR and confidentiality.

3. Please provide a summary of the evidence gathered which will be used to inform your decision-making and the content of the proposal

• Evidence from:

existing research/reports/policy expertise

From the outset, it was decided that the project would be highly targeted to those families living in or at risk of poverty and the data was used to identify where that would be.

The Health and Social Care Partnership (HSCP) in Glasgow looked at the data they already had regarding practices and need in the city in relation to families living in poverty. The HSCP was able to show where the greatest need in the city was and where to target any interventions that would support those families.

The decision is therefore to base the project in the ‘Deep End’, where most of the need has been identified.

The Scottish Deep End Project involves General Practitioners who work in some of Scotland’s most deprived communities and is hosted by the Royal College of General Practitioners. There are around 100 ‘Deep End’ practices in Scotland, defined on the basis of the proportion of patients on the practice list with postcodes in the most deprived 15% of Scottish SIMD data zones. Homeless practices in Glasgow and Edinburgh are also included. The general practice Deep End is a well-established concept in the UK (and has been adopted in some other countries) which focuses on addressing the inverse care law and maximising the primary care’s power to alleviate and prevent health inequalities. This is done through testing new ways of working, sharing and embedding what works, research, and by providing GP leadership on health inequalities.

Tackling child poverty is a critical mission of the Scottish Government, cross-government work and stakeholder engagement is ongoing and the government’s approach is informed by a wealth of evidence and statistics on child poverty.

Evidence is continuously collected against a range of wellbeing indicators, which is helpful for understanding the impact of poverty on children - Children, young people and families outcomes framework - core wellbeing indicators: analysis.

An evidence review on what works in tackling child poverty sets out which approaches are most helpful.

Data shows that children in priority families are more likely to be in poverty and the Scottish Government has compiled evidence on each of the priority family groups.

This project will be based in a sample of ‘Deep End’ practices. These are practices within the top 100 most deprived practice populations. The project will aim to target those who need it most and focus on priority family groups.

Deep End practices have exceptional experience of supporting people who face health inequalities over their lifetimes, with lower life and healthy life expectancy, problems with drugs and alcohol, depression and often high levels of social isolation. Staff in Deep End practices - not just GPs, but nurses, AHPs and Community Link Workers (CLWs), and support staff - necessarily develop skills, knowledge and expertise for tackling and looking beyond clinical solutions or behaviour-change to address complex problems with causes rooted in the wider determinants of health.

Consultation/feedback from stakeholders

The initial idea for the programme came from discussions between Primary Care officials within the Scottish Government and the Office of the Chief Social Worker. Primary Care officials led and engaged with the children and families unit within Scottish Government and asked them to comment on the proposals from their interests.

Primary Care officials also consulted with the Getting it Right For Everyone (GIRFE) team within the Scottish Government. Officials wanted to make sure that the proposal sat well within their proposed framework.

There was broad support for the overall approach, and we confirmed that it built upon previous and existing interventions.

These discussions and subsequent feedback were used to shape the proposal for the funding of the project.

A number of internal colleagues within the Scottish Government were consulted and collaborative work was undertaken before engaging with Glasgow HSCP and the Deep End group.

Glasgow HSCP have engaged with a wide number of stakeholders, services, people in the city to develop this service through their Glasgow Promise Partnership – Consultation exercise

Consultation/feedback directly from children and young people

A large scale consultation exercise had already been conducted with children, young people and families, the Glasgow Promise Partnership – Consultation exercise took place over a ten week period. Consultations were carried out by 24 third sector providers with 387 interviewees and produced over 800 pages of transcripts.

Families stated what they would like things to be improved – they stated they want;

• more information about services
• getting the right service at the right time
• support for as long as needed
• more understanding from professionals
• more joined up services
• local services
• better funding for family support
• whole family support.

This project will be looking to address those improvements noted by families in the consultation.

4. Further to the evidence described at ‘3’ have you identified any 'gaps' in evidence which may prevent determination of impact? If yes, please provide an explanation of how they will be addressed

Glasgow HSCP have awarded the evaluation of the project to Glasgow University to evaluate the work carried out in this programme. As a test of change piece of work, the evaluators will be looking at the following points during their evaluation:

• the impact of the programme in the participating practices. Specifically what difference has having a Family Wellbeing Support worker made in general practice and what are the perceptions of the impact on primary care delivery both within the primary care team and wider stakeholders.
• whether this test of change is an effective way of providing early interventions for families and the impact on general wellbeing.
• the types of families who engaged with the service
• the early signs of change noted with participating families
• the types of interventions most valued and of most use to participating families and practices

Results from the formal evaluation won’t be available until much further into the project, as you would expect, but Scottish Government officials will continue to monitor progress using a steering group.

The Whole Family Support through General Practice steering group is made up of partners involved in the delivery of the programme.

Glasgow HSCP, Glasgow Life, Includem, Scottish Government officials, and Glasgow University as the evaluation partner.

5. Analysis of Evidence

As is set out in Children, young people and families outcomes framework - core wellbeing indicators: analysis children living in the 20% least deprived areas display substantially better outcomes than those in the 20% most deprived areas, and this pattern is consistent across all indicators relating to child development, attainment, mental health, and physical health. This shows that having the project based within Deep End practices, servicing those communities is the correct way forward.

The evidence review on what works in tackling child poverty highlights the need for a person-centred, holistic approach, within a framework of understanding structural barriers, in order to maximise the effectiveness of policies and avoid perpetuating stereotyping and stigma. Also, clear targeting strategies that identify and support priority families are crucial. This is why an approach in the GP practice is thought to be the best option. The Family Wellbeing workers will support families and collaborate with other professionals if required, making sure a holistic approach is carried out.

Data shows that children in priority families are more likely to be in poverty. The Scottish Government has compiled evidence on each of the priority family groups which details the unique structural barriers they are likely to face and emphasises the need for services which address these barriers.

The evidence outlined above demonstrates the link between poverty and poor outcomes for children, and the need to work to shift services to be more person-centred and holistic.

The responses from the Glasgow Promise Partnership – Consultation exercise show that families want timely, local, joined up services that provide the right support at the right time. This is the aim of the Whole Family Support through General Practice project.

6. What changes (if any) have been made to the proposal as a result of this assessment?

None, the proposal should have a direct positive impact on children’s rights and from the evidence and analysis we did not see a need to make changes due to the positive impacts concluded.

We will however continue to monitor and evaluate the project and learn from good practice.