Primary Care’s Role in the Cost-of-living Crisis

Since late 2021 we’ve been staring down the barrel of a cost-of-living crisis.

• Prices of consumer goods and services have risen by 9.6% in the year to October 2022 – the fastest rate in over 40 years (ONS, 2023)
• Rents are higher than at any other point in history (ONS, 2023)
• There is a distinct lack of affordable housing with the average rental property receiving more than triple the number of enquiries than before the pandemic (Landlordvision, 2023)
• In the 12 months leading up to March 2023, electricity prices in the UK rose by 67% and gas prices by an unprecedented 129% (ONS, 2023).

As a result, millions of people across the UK are struggling to meet the fundamental needs of putting food on the table, keeping a roof over their heads, and heating their homes adequately.

But what truth is there behind the claims that the cost-of-living crisis is also a public health emergency? And if it is such, what’s the role, if any, of primary care in assisting those in need?

Financial strain and its impact on mental health

Money does not buy happiness, but it does buy food and pay essential bills. As we become more financially vulnerable, our ability to be in control of making sound financial decisions weakens and our mental health deteriorates too. In fact, according to data for England from the Money and Mental Health Policy Institute, nearly half of people in debt also have a mental health problem.

Research from the Joseph Rowntree Foundation shows more than a million people in the UK are taking on debt just to cover essential bills and charity Debt Justice estimates 12.8 million adults are falling behind on bills or finding repayments a ‘heavy burden’.

With many turning to unscrupulous lenders or ‘buy now pay later’ providers to help fix their financial situation, we are also witnessing a surge in people turning to gambling. GamCare is also reporting an increase in calls from people who have relapsed as financial pressures heighten.

In a recent interview Dr Subodh Dave, dean of the Royal College of Psychiatrists, said “Clinicians can play their part by enquiring about their patients’ financial situations and how this might be affecting their mental health” but noted that “Collaboration is needed from a range of other bodies including financial advice services and social care organisations.”

Financial strain and its impact on physical health

Although the connection to mental health might be more obvious, both acute and chronic health conditions are also affected by the cost-of-living crisis.

Analysts from Citizens Advice found that 30% of renters cannot heat their homes to a comfortable temperature – increasing to 45% of disabled tenants. Those forced to choose “eating over heating” may end up living in cold and damp conditions. Poor living conditions such as this increase the risk of heart attacks and strokes and exacerbate pre-existing arthritic and respiratory conditions.

Gillian Cooper, head of energy policy for Citizens Advice says, “Improving energy efficiency in privately rented homes has never been more urgent. It’s the step needed to keep people’s essential bills low while also helping to protect their mental and physical health.”

The food bank network, the Trussell Trust, has distributed the highest number of food parcels to date – nearly three million emergency food parcels in the past year. This is a clear indicator that food, like heating, has become unaffordable to many.

Higher food prices also mean that people are less able to afford more nutritious food, including fresh fruit and vegetables. As a result, many are at risk of malnutrition and, due to convenient and nutritionally poor food being more affordable, obesity – a major risk factor for three of the greatest burdens placed on our healthcare system – diabetes, cancer and cardiovascular disease.

Who is most affected?

‘The current cost of living crisis is likely to cast a deep shadow over people on low incomes, long after those who are better off feel that the sun has come out once again.’ – Helen Barnard, Joseph Rowntree Foundation.

Although the cost-of-living crisis affects us all, the impact has been felt most keenly by those on low incomes, families with children, ethnic minorities, the elderly, and those living with disabilities. Most of them are also frequent attenders of primary care (BMJ, 2021)

Piling the pressure on primary care

Due to the disproportionate impact on the most vulnerable in society, there is an increased demand for primary care to support those in need as that is a common environment for such groups.

Most recently NICE guidelines are now recommending that GPs should ask people about gambling during consultations, in the same way they ask about smoking or alcohol use, and there are proposals for doctors to ‘prescribe’ money off energy bills for patients.

But doctors’ leaders are warning that piling extra pressure on GPs is not the solution and that they do not have the time or the skills to do the work of the welfare system.

RCGP chair Professor Martin Marshall has said: ‘Action does need to be taken to address this and minimise the impact of rising cost of living on people’s health, something that will impact on our most vulnerable patients most. But this cannot fall to GPs and our teams to facilitate.’

Is Primary Care the Right Place for Cost-of-living Advice?

Despite protests, there are known benefits of co-locating advice services in GP settings, with significant improvements in patient mental health and well-being reaching those most in need.

• People who received welfare advice gained on average £15 per capita for every £1 spent by commissioners – averaging £2,689 per person.
• Patients had up to 91% greater reductions over time in common mental disorders, improved mental well-being and a 58% greater reduction in financial strain.
• Nearly half of the advice recipients would not have sought advice or would have turned to their GP had the service not been there.

As such, it is clear the effects of the cost-of-living crisis permeate many layers of society but that more needs to be done to provide the right support in the right place for the right people.

So what’s next and who can the NHS and its patients turn to?

It’s clear the effects of the cost-of-living crisis permeate many layers of society but more needs to be done to provide the right support in the right place for the right people. One of the right places is primary care.

But if we can’t or shouldn’t rely solely on HCP’s to shoulder the burden personally, what other solutions are there?

Our Head of Marketing recently visited the Best Practice Show in Birmingham and a recurrent theme was the importance of health education in for patients to reduce health inequalities and to encourage patients to live healthier lives. Seems fair to suggest that this could also be a suitable route to pursue for the cost-of-living crisis too?

Over the next couple of weeks we will be doing a deeper dive into this, but in the meantime if you would like to speak to a member of the team about reaching millions of patients every month, many of which are vulnerable and/or from the lower quintile for deprivation then contact us and one of our team will get in touch.