Social problems, primary care and pathways to help and support: addressing health inequalities at the individual level. part II: lay perspectives

Objectives: This study aimed to describe social problems presented to general practitioners ( GPs) in UK inner cities and GPs' responses; describe patients help- seeking pathways; and consider how these pathways can be improved. Methods: The study involved a pilot survey and follow- up qualitative interviews with patients in two inner city areas in London and Salford in 2001 - 2. The pilot survey involved five practices in each locality. GPs completed questionnaires on 57 people presenting with social problems. A diversity sample of 12 patients was followed up for interview. Results: Study results are presented in two parts. Here ( Part II) qualitative research results are reported highlighting four themes: the complex and enduring nature of social problems; the persistence people display seeking help; the fragmented and problematic pathways available; and the roles GPs play as: primary medical adviser; formal gateway to another service; advocates or facilitators to another service; and sources of support and advice during a process of recovery. Commonly, GPs occupied more than one role. Conclusions: GPs do help people deal with social problems, but their responses are limited. More integrated pathways to help and advice for social problems are needed. Existing pathways could be more visible and accessible, and new pathways developed through commissioning and extending social prescribing. More partnerships across sectors may create more co- ordinated provision, but these are notoriously difficult, and other trends such as the focus on lifestyle issues and long- standing conditions may make it more difficult for people with social needs to access support.