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Relationship signposting: another role for GPs?

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GPs may soon see their portfolios expanded even further, this time into relationship  territory, according to the Daily Telegraph. GPs, midwives and registrars may soon be enlisted to help couples stay together and reduce levels of family breakdown under new government plans.

This proposal is being driven by Iain Duncan Smith, the Work and Pensions Secretary, who is well known for his long-term support for marriage in public policy. Apparently he is examining a series of new policies aimed at reducing the stigma surrounding counselling and relationship support services.

One of these new policies is that GPs, midwives and registrars will be encouraged to talk to couples about their relationships. They will then direct couples to one of a number of accredited relationship support services to help bolster their relationships.

There are, I suspect, two main drivers to this policy: the escalating cost of family breakdown and increasing evidence for the direct benefits of marriage.  I’ll expand further on these two shortly, but first, why involve GPs and other health professionals?

A few months ago I wrote a blog on a new report showing the close links between public health and private relationships. This report found that cardiovascular disease, child poverty, alcohol/substance misuse, depression, mental health, mortality rates, obesity/child obesity, children’s mental health/cognitive development and infant attachment are not only specific public health concerns but each one is closely linked to the quality of relationships between couples and within families.

I cite further evidence showing that the quality of people’s relationships has a direct effect on alcohol use, mortality and risk of stroke, to name but a few.

The same report proposed that GPs and other primary care providers should routinely ask patients presenting with long-term health conditions, such as cardiovascular disease or depression or those with substance misuse and alcohol problems, about their relationships and should be willing to commission appropriate relationship support services where necessary.

The report suggests that introducing a relational approach to public health could potentially ‘improve our population’s capacity to sustain strong and stable relationships and thereby improve mental and physical health and well-being.

Iain Duncan Smith clearly sees this close link between public health and personal relationships so he appears to be now putting this proposal on the road towards implementation. His aim is to engage front line public health professionals as signposts to further relationship support or help.

The repercussions of relationship breakdown are not just about the burden of disease but about monetary costs too. So one driver behind the need to increase the take up of relationship teaching and support is the direct, and escalating, cost of family breakdown: the Relationships Foundation estimate that family breakdown costs £46 billion per year, or £1,541 a year, for each UK taxpayer, which covers the additional benefits, tax credits, support and services needed by lone parent families. These figures of course ignore the high personal costs of relationship breakdown.

The Marriage Foundation estimates that by taking measures to address the ‘epidemic’ of family fragmentation, the Chancellor could save up to half of this £46 billion cost of relationship breakdown a year.

Another driver for involving public health professionals is that high relationship quality is well documented as being associated with better physical health and wellbeing. Marriage is a source of a great many benefits and blessings, as this CMF article details. Marriage also plays a crucial role in helping couples stay together. According to research 93% of intact couples with teenage children are married. In contrast, cohabiting parents are four times more likely to split compared to married parents.

A government evaluation recently affirmed the effectiveness and value for money of both preventive and treatment relationship programmes. Yet for every £100 spent after relationships breakdown, the government currently spends just 1.6p on relationship support!

I believe that Iain Duncan Smith is right to try to encourage public health bodies to take more responsibility for relationships. The quality of family relationships is not only a private matter for individuals and families, it has major public health repercussions.  It is time for relationship health to become a central element of public health policy. In the long-term, it should theoretically reduce some of the burden on the NHS.

In principle, it is a good idea to involve those who are at the front line of public health to signpost people to further help. GPs and other professionals are usually respected and trusted by patients and are in a position to ask broader questions about a patient’s health. There is a stigma attached to accessing relationship support and GPs could potentially play a role in helping initiate a change in culture which sees accessing help for relationships as the normal thing to do.

However translating such principles into practice is a completely different matter.  GPs are already overloaded by paperwork, targets, reduced appointment times and I suspect many would not want to be seen to be involved in dishing out any sort of relationship advice. So how this is all worked out in practice is key and for that we will have to wait until June, when the proposals are due to be presented in more detail.

Until then, it seems right to support the principles while questioning the practicalities.

Posted by Philippa Taylor
CMF Head of Public Policy
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