Intended for healthcare professionals

Rapid response to:

General Practice

A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector

BMJ 2000; 320 doi: (Published 12 February 2000) Cite this as: BMJ 2000;320:419

Rapid Response:

Family support and the value of voluntary sector referrrals

Many voluntary sector initiatives offer community support, but as
general practitioners, we are aware that not all those who need help are
ready to receive it. The Amalthea Project, in Avon, was developed to
bridge this gap by facilitating access to the voluntary sector from
primary care. Grant et al's evaluation1 of this makes a real contribution
by measuring both the benefit to patients with psychosocial problems and
the costs of such projects.

While Grant et al confirm that employing referral facilitators results in
both clinical and social improvements for patients, they conclude that it
costs more than usual general practitioner care. Experience of the
Hackney WellFamily Service, a family support project we have developed
jointly with the Family Welfare Association, suggests this is short-
sighted. It fails to take into account the long-term benefits to the
community, and the consequent reduced burden on all support services, if
the cycle of deprivation can be broken.

The WellFamily Service offers similar referral facilitation as the
Amalthea project but combines this with practical and emotional support to
help families build on their own resources and find ways around their
problems. This approach was well received by people of different ages and
ethnicity and reached families who might otherwise have been excluded by
poverty, limited education or lack of confidence.

A recent evaluation2 of the WellFamily Service highlighted a number of
themes. Focusing on the whole family provides an opportunity to support
those who are hard to reach, such as the mother of a delinquent teenager.
Non-statutory help can also overcome client resistance to authority and
gives those at risk a sympathetic hearing in an accessible environment.

Another advantage of a practice-based service is the change it facilitates
within primary care; in our case, this has contributed to a more family-
centred approach throughout the primary care team.
Fundamental to the WellFamily approach is the emphasis on wellness and the
'normalisation' of help-seeking which also underpins health visiting.
This has lead us to explore working with health visitors to expand the
service, an approach which draws from the government's white paper,
"Supporting Families"3. Grant et al have demonstrated that such a service
incurs costs that are not recouped by primary care, but if services like
this, or the WellFamily Service, are to be made more widely available, we
need mechanisms to share the costs between the social and health care

Clare Goodhart

Jonathan Graffy


1 Grant C, Goodenough T, Harvey I, Hine C. A randomised controlled
trial and economic analysis of a referrals facilitatior between primary
care and the voluntary sector. BMJ 2000;320:419-423.

2 Goodhart C, Layzell S, Cook A, Graffy J. Family Support in General
Practice. J R Soc Med 1999;92:525-528.

3 Supporting Families: A Consultation Document. London, HMSO, 1998

Contact details:
Statham Grove Surgery,
Statham Grove,
London, N16 9DP

Current appointments:

Clare Goodhart is a Principal in General Practice

Jonathan Graffy is a Principal in General Practice and Senior
Lecturer in General Practice and Primary Care at Queen Mary and Westfield

Competing interests: No competing interests

21 February 2000
Clare Goodhart
Jonathan Graffy