Reading about the current government’s scheme to embed employment advisors into GP surgeries to help people back into work is another example of a well-intentioned initiative that is nothing but a sticking plaster over a systemic problem. One that is likely to end up a range of unintended consequences. The logic, that this is a good way to cut the benefits bill, driven in large part by the number of people too ill to work and often on long-term sickness benefits, seems reasonable at face value. But I instinctively have a negative reaction to this and so I am left to figure out why. 

It adds to the already rich history of tacking on services to the health sector, and GPs in particular, most notably social prescribing. This places advisers in surgeries whose role is to help match people with low level health needs to the kind of community support or activity that might help their general wellbeing. Green prescribing^⁠ takes this into the niche of encouraging people out into nature. Now, add employment advisors. What is so wrong with that? 

Several things. It assumes that if only we could get the right advice to the right people at the right time they will magically find work. That there are appropriate jobs in the area. That people want to go their surgery for advice on something that is not medical. That GP surgeries are accessible. That people just need a ‘nudge’ to work. That their illness or conditions are not significant enough to keep them permanently out of the workplace. That there are not a breadth of other issues impacting their employability (mental health, transport/access, skills, etc). That there is even space in the surgery for an advisors office. 

It assumes that getting people back into work is the best way to lower a welfare bill driven by ill-health conditions. It’s to try and help people at the end of a process that has led to poor health, rather than tackling and addressing the true causes. Sticking plasters over a problem, like so much government policy, not the deep and hard work of seeking to address the underlying issues that might lead to higher levels of poor health. A lack of opportunity, readily available ready meals and junk food, cost of living, addictions, mental health challenges, lack of exercise, and so on. 

And so we are at risk of turning GP surgeries into one-stop shops, a kind of A+E for social ills of all kinds, whereby you can turn up with your presenting social challenges and receive support. Councils and public sector partners have been seeking to provide a ‘no wrong door’ approach to accessing public services for years. They needn’t have bothered. Surgeries are the answer. Benefits advice? Want to know where your local bowls club meets? Employment support? Housing query, debt advice? Don’t know what you want but just want a chat? Roll up, roll up! 

Oh, but wait. Who really wants to go to their GP surgery if they can help it? Lining up with everyone with an illness or medical condition only to see a different kind of advisor. Just because the NHS is the sacred cow of UK public services doesn’t mean we should load it up with any new policy prescription to ensure its uptake.  

Surely we should be focusing on addressing issues at source instead. One that gets below surface value and offers individualised, tailored support. That worries less about the mechanics of delivery and seeks to understand what’s causing the demand in the first place. Putting the human back into public services. In the long run term it’s the true sustainable solution.