Using volunteers to deliver healthcare
Volunteers can provide a low-cost source of labour for health schemes – and the act of volunteering has benefits too. Three GP commissioners give their own experiences.
Volunteering has long been a staple of the social care and charity sectors, but GPs have traditionally hesitated before using unpaid workers. Many would argue that there is little opportunity for patients to contribute to primary care because they lack a clinical background, but GPs are beginning to find opportunities to involve patients more in local healthcare services. The obvious benefit to GP commissioners is the low cost, but volunteer schemes can still be challenging to set up and time consuming to run given the low or non-existent levels of clinical skill among most volunteers. Here, three GPs give their advice on how to use volunteers safely and effectively.
Dr Michael Dixon, Cullompton, Devon: Volunteer counselling
At my practice, we employ volunteers according to their background. At the more experienced end, we have two counsellors with a community background – a former health visitor and primary school teacher. At the less experienced end, we have a gardener's group and a fundraising team. All the volunteers are overseen by our health facilitator Ruth Tucker, who is employed part-time by the practice.
We also offer patient groups for those with long-term conditions such as fibromyalgia and diabetes.
Social isolation can be a big problem, so to try to overcome this we have a café facility, which the gardeners' group produces vegetables for. The gardener's group also offers herbal remedies as alternatives to prescriptions where we GPs consider it appropriate.
Our costs are minimal, and there is even a cost benefit for schemes like our borrow-a-book service, where a per-book charge of £1 has added up to enough for us to buy an ECG.
We have had to pay for Criminal Records Bureau checks for our counsellors, but while there's no direct saving, having them working with our practice has taken the pressure off child and adult mental health referrals by providing an opportunity for low-cost early interventions. The counsellors pay for their own insurance.
A project at our practice to promote gentle exercise in 2009 used volunteer-led activities such as walking, gardening and ‘exercise on prescription', and found that participants managed to lose weight, stop blood pressure medicines and relieve depression symptoms.
We saw a small reduction in the number of clinical appointments booked in the six months following the intervention, especially among high-demand patients.
We've found the greatest cost of having volunteers is employing a health facilitator, but the role ensures that we have well-organised patient groups, good training and strong links to the wider local volunteering scene.
Dr Sam Everington, Bromley by Bow, east London: Volunteering as therapy
The Bromley by Bow Centre (BBBC) has been offering people in a deprived area of east London support on their health, education and employment for over 20 years. My practice, the St Andrew's Centre, is located on site and offers support to the health centre based on four key aims – supporting patients' education, creativity, employment and environment.
The BBBC accepts 3,500 referrals a year from the borough of Tower Hamlets. Dan Hopewell, director of strategies at the BBBC, estimates GPs at my practice make 20 to 30 referrals to them a month, often taking the patient from their GP consultation straight to the office of the person in the BBBC the patient is being referred to.
Many of our referrals send patients to the Time Bank scheme, where they are asked to assess their skills and needs and to join a skills exchange programme.
Rather than recruiting volunteers to work with patients, patients are often ‘treated' by registering as volunteers. The scheme currently has around 100 members with 50-60% engagement in volunteering activities.
The BBBC also offers health projects for specific patient groups, such as Pollen – a horticulture therapy group for patients with mental health issues. Funding comes from outside the BBBC for this scheme, which has been specially commended by the charity Mind.
Vulnerable adults can attend a day centre at the BBBC, and we target patients for whom English is a second language through early intervention and cancer screening outreach among local students.
Queen Mary University is currently in discussions with the BBBC to develop a programme for volunteer and work experience medical students to work as health navigators in the reception area of our practice and the BBBC, and to pursue follow-ups after appointments.
The health navigators will then assess the patient's condition, recommend a good self-care programme and put them in touch with support groups where appropriate – for instance, for weight loss or diabetes.
The two main opportunities I see in volunteer schemes are encouraging patients to take more responsibility for their own health, and the big wins available through better lifestyle.
Many of the things GP commissioners aim to target – areas of health spend such as emergency admissions and disease areas such as diabetes – can be dramatically improved by giving patients better resources for dealing with their health problems and by changing their diet and exercise habits.
Volunteer schemes can be a good, low-cost way for us to reduce our workload by delegating healthcare back to patients.
The cost to the practice is hard to assess, but one of my partners dedicates one to two days a week to help manage the BBBC's activities. The integration extends both ways, with the chief executive of the BBBC working as a non-profit-sharing partner of our practice.
Dr Amit Bhargava, Crawley: Carer support networks
Volunteer services make a strong contribution to our practice brand and help us maintain our rate of list growth – currently sitting at 85 to 100 new patient registrations a month. Neighbouring practices that offer similar volunteer-run services are also experiencing a comparable level of list development.
The main strategy for our volunteer schemes is to make them self-sustaining, so they create a zero-cost clinical benefit to GPs without requiring time or financial input from us.
We started with offering a general support network for carers, but as it grew we established more specific groups – for example, for Alzheimer's disease and back pain.
Initially we offered simple social meetings for carers in the networks, but we now provide health education sessions too.
We employ a co-ordinator for our volunteer schemes who works 12 hours a week, but managing the volunteer schemes is only part of her role and the groups mostly organise themselves.
The practice makes no financial input to volunteer groups and, as it doesn't charge rent even to private health providers using rooms on the site, there is no loss of income from providing volunteer-run groups with a place to meet.
Some successful programmes we participate in were suggested by our carer groups. So for example, we encourage people to use the ‘This is me' scheme run by the Alzheimer's Society, in which patients or their carers fill in a questionnaire with photo ID, describing the patient and their health needs and medicines, and providing contact details for their main carer. It has been shown to help reduce the average length of hospital stay for participants.
We also have an armchair exercise group for the frail elderly, which is provided and run by the local branch of Age UK.
Early intervention is the main objective of our volunteer services, and our 8% reduction in unscheduled admissions since last year can be partly attributed to their introduction.
Since we introduced our volunteer services, demand for GP appointments and requests for home visits have also gone down.