Long Term Social Work in a Primary Health Care Setting

Abstract

SUMMARY This study was designed to explore which factors characterise long term clients and to investigate the relationship between the burden on medical and welfare resources in a general practice setting. Two groups of clients were studied; 135 long term clients referred over a five year period, where contact was maintained for a minimum of one year and 157 cases referred during a six month period, in all of which the duration of social work intervention was less than 12 months. Few differences were found between the characteristics of the two groups, nor did any individual social worker emerge as being particularly predisposed to maintain long term contact. However, a significant change in the proportion of referrals which became long term was found over the five year period under consideration, and policy regarding the handling of cases was therefore felt to constitute a major influence on the length of contact with any particular client. Relationships with other members of the primary health care team were generally found to be good, especially in relation to the long term clients. Moreover, the GPs' workload with regard to these clients was found to be reduced following social work intervention. These clients' consultation rates dropped significantly after receiving social work help, and continued to drop when the case had been closed. It has recently been estimated that as many as 10% of the population are unable to look after themselves, and must be cared for (Morris, 1977), a figure strangely reminiscent of Charles Booth's (1904) submerged tenth of the population whom he identified as living in vice, squalor and poverty at the turn of the century. The proportion of such socially maladjusted problem families has since been reduced 60-fold (Tonge, James and Hillam, 1975), so that now most of the deprived section of modern society comprises those who are old and/or frail, the physically and mentally disabled, and children. However, it has been observed that a small number of chronically disorganised and disturbed families take up an inordinate amount of social work resources, sometimes over many years, with few visible results (Goldberg et al., 1978).

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