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The missing link

The missing link
23 April 2015

Tackling young people’s health issues has become an increasing problem.
A scheme set up in Liverpool implemented a way to bridge the gap between young people and GPs

Tackling young people’s health issues has become an increasing problem.
A scheme set up in Liverpool implemented a way to bridge the gap between young people and GPs

GP Champs was initially a three-year national project, funded by the Department of Health and Paul Hamlyn Foundation (an independent grant-making foundation). Its aim was to transform the delivery of health services for young people by creating innovative new links between GPs and the voluntary sector.
The work was piloted in 10 areas in England. Activities have included joint national learning events and the design and implementation of innovative ways to improve the health offer to young people. The model varied in all 10 sites.

Why does young people’s health matter?
Young people have experienced the least improvement in health status of any age group in the British population over the last 50 years. This matters because poor adult health frequently has its roots in adolescence. The second decade of life is a key time for health – it is the time when most risky health behaviours are likely to start and it is also a time when a range of health behaviours for older adulthood is set.

Despite the risks during adolescence and into young adulthood, young people’s health needs are often overlooked in the current health system: permitting opportunities for early intervention and prevention to be missed. The reasons are largely due to a health system that persists in focusing its main attention on the early years and older adults. The lack of focus on young people’s health needs has consequences for us all. While untreated or poorly recognised health problems clearly create difficulties for the individual and their families, they also create long-term pressures on an already hard-pressed health system and wider costs to the public purse.

Numerous government and independent reports over the past 40 years have recognised the benefits of addressing the unmet need for this age group through an integrated youth, information, access and counselling service (YIACS) type model of support for young people. Those to publish such reports recently include: the Department of Health; the Department for Education; Social Care Institute for Excellence; the Social Exclusion Unit; the Mental Health Foundation; the Marmot Review; and the Audit Commission. However, despite such reports, investment in services for this age group is small and current service provision is not designed to meet their needs.

A recent report by Youth Access found that:

  • Seventy eight per cent of young people prefer using advice services specifically aimed at young people.
  • Eighty per cent feel it is important to get help with everything that is troubling you in one place.
  • Eighty five per cent of young people would design mental health services that go up to age 25.

The most common presenting issues in young people are:

  • Mental and emotional health.
  • Sexual health.
  • Homelessness.
  • Relationships.
  • Money and benefits.
  • Drugs and alcohol.
  • Safeguarding.
  • Education and employment.
  • Issues are frequently inter-related – requiring an integrated response to young people’s emotional, health, social and practical needs.

The GP Champs scheme
The Liverpool GP Champs scheme consisted of the Young Person’s Advisory Service (YPAS) YIACS (integrated youth, information, access and counselling service), partnered with Brownlow Health (an NHS GP practice providing general medical, student health and homelessness services). Following an extensive consultation with Liverpool’s young people, the project was successful with funding from Liverpool CCG Innovation Grant.

This is a truly innovative project that has developed a service designed by young people for young people. They have designed the young person friendly clinical consulting room in the YPAS building. This has allowed the GP to offer a weekly two-hour surgery in combination with a health drop-in that is facilitated by YPAS staff.

YPAS’ GP health drop-in offers a non-stigmatising and accessible service to the ‘hardest to reach’ young people with a diverse range of health issues. This collaborative working relationship has supported the delivery of integrated care, coordinated and tailored around the individual needs of young people. The Liverpool project has generated evidence of a significant impact based on the health outcomes of Liverpool’s young people. This has resulted in further investment from Liverpool clinical commissioning group (CCG).

The evidence and intelligence from the consultation is highlighting a need to educate health professionals that deliver frontline services to young people on approach and attitude. It has been identified through this consultation that adult clinical staff generally treat young people like adults and expect them to take responsibility for their own health care. What is not taken into consideration is that many young people have had complex issues for much of their lives. They can be immature and vulnerable; many of the young people working with GP Champs project have parents with complex issues or are estranged from their families. If vulnerable young people do not have parents/carers to support and guide them they risk dropping through the gaps in provision.

This project provides an opportunity to have a service with, ‘parity of esteem’ by having an accessible service for young people that holistically values mental health equally with physical health. Sustaining this project will enable Liverpool to continue to tackle stigma and prejudice that may stop young people with serious mental health problems getting treated with the same vigour as if they had a physical illness such as diabetes. Parity is also about tackling the physical illnesses of young people with severe mental health problems. Currently in Liverpool some young people have the same life expectancy of people who lived in the 1950s – some 10 to 15 years shorter than average.

The outcomes
The emerging data on young people’s use of this service and their outcomes is demonstrating:
Reductions in further risks to health, as young people said that without the service, they would have waited until their health needs had worsened or reached crisis point before seeking help. Generating savings to the public purse, as 50% of young people’s presenting issues would have escalated and required referral to social care, crisis teams or A&E without the service.

The project supports the local Healthy Liverpool programme (aimed to provide a new health and social care system to transform the health of everyone in Liverpool) through providing innovative ways of working in primary care to improve health outcomes for Liverpool’s most marginalised young people. The service is designed to engage 14-25-year-olds and therefore crosses children and adults’ services that also support the developments in the transition element of the Children’s Healthy Liverpool work stream.  

GP Champs has a steering group of young people who have designed resources to educate health professionals working in GP surgeries on how to work effectively with young people. This steering group, with the support of Dr Exley (from Brownlow Health), will access health care professionals to deliver the training in a way that is accessible for GPs and practice staff given their current time commitments.  

The project’s next step
The next step of the project is to develop the young people as young advisors/auditors to shape the health services available to children and young people, throughout Liverpool. This will build on the Your Welcome model that was rolled out in some specialist services a few years ago.

The Liverpool GP Champs project has set up a cross-sector reference group of professionals from YPAS, Brownlow Health, Barnardo’s, South Liverpool Homes, Inclusion Matters, Mersey Care, Transition (CQUIN), Liverpool Mutual Homes, Merseyside Youth Association, Liverpool CCG, Early Intervention, Roy Castle Foundation and Liverpool Mental Health Consortium. The group aims to improve health outcomes for young people through better partnership and integration of services working across primary care.

Val O’Donnell is senior operational manager at the YPAS in Liverpool.

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