Skip to main content
Download PDF

Social issues in general practice – a survey assessing the interprofessional perspective of general practitioners and social workers regarding frequency, challenges, and needs

BMC Primary Care volume 26, Article number: 11 (2025) Cite this article

Abstract

Background

Health or illness and social issues cannot be viewed in isolation. Social problems can influence well-being and disease. General Practitioners (GPs) are requested to offer counselling opportunities to respond to the social issues of their patients adequately. Counselling on non-medical issues in general practice increases GPs’ workload. The study aimed to analyse the occurrence of social problems as well as the strengths and weaknesses of existing working agreements between social services and GPs in primary care.

Methods

We carried out a cross-sectional online survey between December 2022 and January 2023 among a sample of Swiss GPs from the Sentinella-Network, the uniham-bb-Network and social workers from the SAGES-Network.

Results

Findings come from a sample of 143 GPs (mean age 54 years, 37.8% female) and 41 social workers (mean age 43 years, 75.6% female). GPs face a median of 3 patients with social problems per week (IQR 5.2). They reported encountering patients facing “Finance” issues most frequently, with 78.8% encountering such cases between “more than 3 patients per week” and “1–3 patients per month”. “Work” (76.4%) and “Loneliness” (73.7%) were also among the most commonly encountered social problems. When suspecting the problem, GPs more often addressed the issue if it was about “Addiction” (83.2%), “Loneliness” (72.3%), or “Protection” (71.4%). More than half of GPs (56.0%) reported having contact with social workers less than once a month, while approximately half of the social workers reported having contact with GPs 1 to 3 times a month (48.7%). GPs (69.3%) and social workers (76.3%) would like more contact. The most frequently mentioned benefits of an increased collaboration from the GPs’ perspective were “improved quality of care (more time for medical issues)” (64.8%) and “improved mental health of patients” (55.6%).

Conclusions

Social problems in general practice are common, but the interprofessional cooperation between GPs and social workers is scarce. However, both parties appear to be in favour of closer interprofessional collaboration and seem to be willing to attempt to improve joint patient care in the future. The integration of social workers into general practice is promising for a comprehensive, interprofessional, and preventative patient approach to providing the best healthcare.

Peer Review reports

Background

Health or illness and social issues cannot be viewed in isolation [1]. Social problems can influence many aspects of well-being and disease. Patients not only declare their medical but also their social questions, needs, and problems to their healthcare providers. Social aspects such as unemployment, financial constraints, distress in the family or partnership problems, concerns at the workplace, or problems due to ageing can have a massive impact on a person’s well-being [2,3,4]. If ignored, unfavourable social circumstances may considerably influence the course of treatment or the outcome of a disease.

In general, the lower a person’s socio-economic status, the worse the health outcomes and the higher the risk of premature death [5]. Furthermore, people with lower levels of education have a higher risk of suffering from certain illnesses than those with a high level of education [6]. People with social worries have more frequent psychological impairments [7], suffer more often from multimorbidity [8], have increased mortality rates [9], report a lower quality of life [10], and show more mental health problems [11]. Therefore, dealing with social issues in health care is crucial.

Since health care in general practice is longitudinal, i.e., during a long period of an individual’s or patient’s lifetime, for General Practitioners (GPs) to deal with the social aspect is of concern in all age groups. Thus, enhanced awareness and specific expertise by GPs about social problems are demanded. GPs are requested to offer counselling opportunities to adequately respond to any unfavourable changes regarding the social issues of their patients. However, counselling on non-medical social issues in general practice is challenging. One major point is GPs’ lack of time to use and maintain the network of available offers of social services in the specific area where they practice [12]. In Switzerland, a variety of organisations offer social counselling. These include larger and smaller associations, primarily organised at the cantonal and regional levels (a canton in Switzerland is a political and administrative unit that corresponds to one of the country’s 26 main regions). Some specialise in specific health areas (e.g., Lung League, Cancer League) or focus on particularly vulnerable population groups (e.g., older adults, people with a migration background, individuals affected by poverty) [13, 14].

Another important issue is GPs’ possible knowledge gaps in social counselling as social medicine is less frequently discussed during medical school and continuous education than disease-centred topics [15]. Results from a qualitative focus group study showed that during a consultation non-disease-related concerns are considerably challenging, and GPs must improvise to a substantial extent in terms of counselling on the best way to cope with the social concerns of their patients [15]. New models of health care are emerging and supported to improve individualized patient care by pooling available resources and eventually saving costs [16]. These care models often deploy interprofessional teams of physicians and GPs, nurses, physiotherapists, occupational and social workers, and other allied health professionals. These efforts aim to provide health services that concurrently address physical and mental health and social well-being.

The Swiss healthcare system is federalistic in nature. The cantons have extensive powers in the healthcare system, for example in hospital care, cutting-edge medicine, licensing to practice medicine and prevention. The Confederation, for its part, is responsible for compulsory health insurance, combating communicable diseases and reproductive and transplantation medicine [17]. Healthcare costs are mainly borne by the social insurance funds, private households and the cantons, whereby the largest share has been borne by compulsory health insurance for years [18]. In Switzerland, hospitals and psychiatric outpatient clinics already work closely with social workers. In contrast to the hospitals and psychiatric outpatient clinics, social workers in general practice are rarely encountered. There are a few reports on this topic arguing that the integration of social workers in Swiss general practices might lead to an improvement in the subjective state of health, self-management, and a reduction in psychosocial morbidity of patients [19]. Additionally, social workers integrated into practices can alleviate the time-consuming social coordination tasks of GPs [20]. Consequently, it is urgent to investigate perceptions of the joint working of GPs and social workers in Switzerland. This study aimed to analyse the occurrence of social problems as well as the strengths and weaknesses of existing working agreements between social services and GPs in primary care. Additionally, it sought to examine the obstacles and requirements necessary for effective collaboration between these two components in delivering high-quality care.

Methods

Study design and participant recruitment

We conducted a questionnaire-based cross-sectional online survey among GPs and social workers in Switzerland in December 2022 and January 2023. GPs were recruited through two primary channels: the Sentinella Network [21] and the Network of the Centre for Primary Health Care at the University of Basel (uniham-bb) [22]. The Sentinella Network, encompassing GPs nationwide, serves as a platform for monitoring communicable acute diseases and conducting research in family medicine. Conversely, the uniham-bb Network includes GPs primarily from the Northwestern region of Switzerland. 171 GPs from the Sentinella Network and 340 from the Uniham-bb Network were invited to take part in the study. The social workers were recruited via the “SAGES” Network [23], whereas approximately 1000 social workers were contacted. The Swiss Association of Social Work in Health Care (SAGES) brings together members who provide professional social work in the fields of health care and public health. Both GPs and social workers were contacted via email, the social workers, to be more precise, via newsletter. Following the initial email distribution, a reminder was sent to both GPs and social workers one month later to increase the recruitment rate.

Questionnaire and data collection

The questionnaire administered to GPs was adapted from an existing study conducted by Zimmermann et al. at the University Medical Centre Hamburg-Eppendorf, Germany [24]. This instrument was developed, drawing from the “Chapter Z Social Problems” of the International Classification of Primary Care, 2. Edition (ICPC-2) [25], as well as the Z diagnoses outlined in the International Classification of Diseases and Related Health Problems, 10th Revision, German Modification (ICD-10-GM) [26]. The primary aim of questionnaire development was to ensure alignment with the prevalent social issues encountered in primary care settings, while also prioritizing simplicity and efficiency for GPs during completion. This involved condensing 29 problem areas delineated in the ICPC-2 classification into a concise set of ten health-related social problems. The following social issues were listed in the questionnaire: “Financial problems (Finance)”, “Workplace and unemployment problems (Work)”, “Problems with loneliness and social isolation (Loneliness)”, “Relationship problems (Relationship)”, “Problems related to addictive disorders (Addiction)”, “Socio-cultural problems (Culture)”, “Problems with illness or death (Illness)”, “Educational problems (Education)”, “Housing and neighbourhood problems (Housing)”, “Child and adult protection problems (Protection)”. The terms in parentheses correspond to the terms used in the results section. For every social problem asked, participants were presented with four questions (see Table 1) [19]. Furthermore, an additional part was appended to the questionnaire to explore the collaboration between GPs and social workers. The questions in the additional part were developed by the study team to gather information on both quantitative and qualitative aspects of interactions between GPs and social workers. This section also aimed to capture GPs’ perspectives and attitudes regarding the future organisation of collaboration of GPs with social workers. Questions were designed and selected through team consensus to identify those most relevant for assessing collaboration between GPs and social workers. No validated instrument was found in the literature that addressed all targeted aspects. The questions were piloted with a group of five external GPs outside the study team, who provided feedback on clarity and wording, leading to further refinement of the questionnaire. The questionnaire for social workers closely resembled that of the second part designed for GPs, ensuring consistency and comparability in responses. Both questionnaires are listed in the additional files 1 and 2. The questions were asked via SurveyMonkey, an online survey tool.

Table 1 The four questions and answers asked for each social problem (10x)
Full size table

Statistical analysis

Descriptive statistics were used to assess the sociodemographic characteristics of participants (GPs and social workers). Thereafter, we calculated the median and interquartile range (IQR) of the number of patients with social problems seen by each GP per week. To achieve this, responses to the questions, “How many patients do you see in the practice with this problem (“Finance”, “Work”, “Loneliness”, etc.)?” were converted based on their minimum frequency: “More than 3 patients per week” = 4 points (at least 4x/week); “1–3 patients per week” = 1 point (at least 1x/week); “1–3 patients per month” = 0.25 points (at least once every 4 weeks); “1–3 patients per quarter” = 0.0833 points (at least once every 12 weeks); “none” = 0 points (never).

This was followed by the evaluation of the four questions above per each social problem. To analyse the first two questions, namely “How many patients do you see in the practice with this social problem?” and “What do you usually do in situations where you suspect the problem?” we created frequency tables and illustrated them with Likert plots. The remaining two of the four questions above were multiple-choice, namely “What do you usually do when the problem arises?” and “What would you be interested in to be able to manage the problem better?”. For these, we also created frequency tables and displayed the results with individual bar plots for each answer option related to each social problem. The remaining questions were also evaluated descriptively using frequencies, proportions and mean values.

To assess the association between the frequency of patients presenting with social problems and GP- and practice-specific variables we used multivariable logistic regression. To evaluate the collinearity among the social problems, we employed a correlation matrix, which demonstrated moderate to strong correlations in most instances. If a problem was frequently perceived by a GP, other problems were also frequently perceived—and vice versa. Consequently, to address this collinearity, the frequencies of the problems were transformed into ranks ranging from 1 to 5 [24]. Based on the question “How many patients do you see in the practice with this social problem?” each of the ten problem areas was assigned a score from 1 (representing experiencing no patient with a social problem) to 5 (representing experiencing more than 3 patients per week with a social problem”), which were then summed. This process converted the GPs’ perceived problem frequency into rankings ranging from 10 to 50 points (10 = no patients were seen for each social problem, 50 = more than 3 patients per week were seen for each social problem). The ranking’s median (which was 26) was used to create two statistically balanced groups of GPs: those who recalled fewer patients with social problems (< 26 points) vs those with more patients with social problems (≥ 26 points). A logistic regression model with covariate GP- and practice-specific variables (sex, age, language region (German vs. non-German), practice size (group- vs. single practice) and number of people per practice) was then calculated. The significance level for the multivariate analysis was set at p < 0.05. Statistical analysis was conducted in R [27].

Results

Sociodemographic characteristics

A total of 145 GPs participated by filling out the questionnaire, resulting in a response rate of 28.4%. Furthermore, 55 social workers took part in the survey, yielding a response rate of 5.5%. 14 social workers were excluded from the analysis because they had no contact with GPs in their daily work. 2 GPs were excluded from the analyses due to incomplete questionnaire submissions. Ultimately, data from 143 GPs and 41 social workers were analysed. The sociodemographic characteristics of both groups are detailed in Tables 2 and 3.

Table 2 Characteristics of GPs and their practice
Full size table
Table 3 Characteristics of social worker
Full size table

Prevalence of social issues in general practice

GPs face a median of 3 patients with social problems per week (IQR 5.2) (see Fig. 1). Figure 2 illustrates the frequency of social problems patients present to GPs. The GPs reported encountering patients facing “Finance” issues most frequently, with 78.8% encountering such cases between “more than 3 patients per week” and “1–3 patients per month”. “Work” (76.4%) and “Loneliness” (73.7%) were also among the most commonly encountered social problems. “Education” (38.2%), “Housing” (33.6%) and “Protection” (11.1%) were observed less frequently by GPs. When social problems were integrated into consultations, nearly half of the GPs (46.4%) indicated that such discussions consumed more than 50% of the entire consultation time.

Fig. 1
figure 1

Number of patients with social problems seen by each GP per week

Full size image
Fig. 2
figure 2

How many patients do you see in the practice with this social problem? Answers in frequency (%)

Full size image

Multivariate analysis - Which GP- and practice-specific factors are associated with the frequency of patients presenting with social problems?

Upon computing the rank sums derived from the frequency ratings of patients presenting with social problems (ranging from 1 to 5), we built two distinct response groups: those whose GPs recalled fewer patients with social problems (n = 64; 44.8%) and those with more patients with social problems (n = 79; 55.2%). A logistic regression analysis of the cumulative risk scores was conducted to identify GP- and practice-specific factors that influence GPs’ perceived frequency of patients with social problems.” The analysis revealed no significance within the overall multivariate model, indicating that no GP- or practice-specific factors (e.g. sex, age, language region) exerted a notable influence on the frequency of social problem occurrences (see Table 4).

Table 4 Multivariate logistic regression analysis of the ranking sums (cumulative problem frequencies)
Full size table

Social problems suspicion

The initial response option for the question “What do you usually do in situations where you suspect the problem?” was “I avoid the topic”. This was stated by less than 2% of respondents in 9 out of 10 problem areas. Slightly higher avoidance rates were noted for the topic “Culture” (6.0%). There was a tendency to actively address issues related to “Addiction” (83.2%), “Loneliness” (72.3%), and “Protection” (71.4%). When confronted with “Housing” (60.7%) and “Education” (59.4%) concerns, GPs more frequently opted to await the patient’s initiative before addressing the problem, as depicted in Fig. 3. The data revealed that non-responsive behaviour was least prevalent concerning the topic of “Addiction” (16.8%), showing a proactive approach among GPs in addressing this particular social problem.

Fig. 3
figure 3

What do you usually do in situations where you suspect the problem? Answer in frequency (%)

Full size image

Social problem present

In response to the question, “What do you usually do when the problem arises?” the predominant choice among GPs was to “pass on information, addresses and contacts”. Apart from the problem domains of “Protection” (n = 81, 56.6%) and “Education” (n = 86, 60.1%), this approach was favoured by over 100 out of the 143 participating GPs (71.7% on average). Second, GPs tended to collaboratively seek solutions with the patient without external assistance (69.7% on average). This strategy was adopted by more than 100 GPs across 5 problem areas, most notably in “Loneliness” (n = 113, 79.0%), “Education” (n = 110, 76.9%), and “Work” (n = 108, 75.5%). In these particular domains, as well as in “Illness” (n = 104, 72.7%) and “Relationships” (n = 105, 73.4%), this cooperative method exceeded the tendency to solely provide information, contacts, and addresses. Engagement with institutions was notably less frequent, both during (18.0% on average) and after (39.9% on average) consultations. An exception was observed in the “Protection” domain, where contact with institutions occurred more frequently (n = 87, 60.8%) than suggestions for obtaining information, addresses and contacts or collaborating with the patient to find solutions, as illustrated in Fig. 4.

Fig. 4
figure 4

What do you usually do when the problem arises? Multiple answers possible, N = 143 GPs

Full size image

Social problems management

In response to the question, “What would you be interested in to be able to manage the problem better?” participants were provided with seven response categories, allowing for multiple selections. Across all 10 problem areas, direct contact with a social worker emerged as the most commonly desired resource (e.g. direct telephone or email contact with a social worker, for example, from a counselling centre, who can advise or refer the GP on various social problems). On average, this preference was expressed by 101 out of 143 GPs (70.3%) (see Fig. 5). In second place, for all problem areas except “Protection”, GPs expressed interest in an Internet platform for addressing social problems (39.9%). Thirdly, GPs favoured the establishment of a hotline (32.5% on average). On average, 27.1% of GPs expressed an interest in joint training events involving GPs, specialist council members, and social workers. Networking meetings, such as round table discussions with social workers, received interest from an average of 21.7% of GPs. Interests in quality circles (11.9%) and problem discussion meetings with colleagues (8.5%) were less frequently mentioned by GPs.

Fig. 5
figure 5

What would you be interested in to be able to manage the problem better?

Full size image

The social workers were asked a similar question: “What would you be interested in doing to improve cooperation with GPs?” The social workers predominantly expressed a desire for network meetings (52.1%) and consultation hours within GP practices (50.5%) to facilitate discussions on social problems.

Cooperation between GPs and social workers

Among the GPs, the most common frequency of contact with social workers was less than once a month, as reported by 56.0% of respondents. In comparison, approximately half of the social workers reported having contact with GPs 1 to 3 times a month (48.7%). Social workers indicated the most frequent contact with GPs occurred between 1 and 3 times a month (48.7%). When asked about their desired frequency of contact, both groups expressed a desire for increased interaction, with 69.3% of GPs and 76.3% of social workers seeking more contact. The primary reasons cited by GPs for wanting more contact included “delegation of social tasks” (46.6%) and “increased need in my practice” (40.6%). The most frequently mentioned benefits of contact from the GPs’ perspective are depicted in Fig. 6a. Figure 6b shows the motivation of GPs to employ a social worker within their practice. A significant majority of social workers (78.9%) expressed openness to working part-time in a general practice.

Fig. 6
figure 6

A Benefits of contact with social workers from the GPs’ perspective B Can you imagine employing a social worker in practice? *of patients. Multiple choice answers, percent do not add to 100%

Full size image

Obstacles to cooperation

When queried about potential obstacles affecting collaboration, both GPs and social workers identified several challenges. Most prevalent was “difficult accessibility,” reported by 57.8% of GPs and 71.0% of social workers. Both groups expressed concern regarding the “lack of knowledge of each other’s possibilities,” affecting 56.1% of GPs and 65.8% of social workers, as well as the “lack of funding,” influencing 48.8% of GPs and 50.0% of social workers. Obstacles such as the “lack of need” (GPs 8.2%, social workers 5.2%) and “lack of trust” (GPs 5.7%, social workers 10.5%) were deemed less relevant to collaborative efforts. Further insights into these findings are presented in Fig. 7.

Fig. 7
figure 7

Assessment of the perceived influence of obstacles affecting the cooperation between GPs and social workers. Zero point is the Likert scale “medium”. Obstacles are ordered by frequency (%)

Full size image

Discussion

This study is a survey among GPs and social workers assessing their collaboration and the prevalence of patients with social issues within the context of general practice. Our findings indicate that social problems are widespread in general practice. Particularly, financial issues, problems with (un-)employment, and challenges related to loneliness and social isolation were most frequently reported by GPs. Less frequently, patients reported social issues related to child and adult protection, education, and housing, including neighbourhood concerns. Interestingly, GPs were more inclined to actively address problems related to “addiction”, “loneliness”, or “protection” compared to issues concerning “education” or “housing.” The German study conducted by Zimmermann et al. examined analogous issues. The study revealed that 47.8% of GPs reported encountering at least 5 social problems every week. Similar to our findings, the areas of “work” and “loneliness” were commonly addressed by GPs. The predominant social problem identified was “poverty,” which closely corresponds to our most frequently mentioned category of “finances.” In both cases, the primary issue was the lack of financial resources [24]. A study conducted in the United States by Bikson et al. showed that patients reported experiencing similar psychosocial problems. The most prevalent issues in this study from the US included concerns related to finances, personal stress, transportation, (un-)employment, and legal matters [28]. In a Swiss context, Rüegg et al. examined the role of social work in primary care and found similar trends, i.e. the most common reasons for referring individuals to social counselling were financial issues, insurance problems, and employment-related challenges [19]. Financial difficulties emerge as a significant burden for patients and seem to be the most prevalent social problem.

Most patients referred by physicians to social counselling are coping with one or more chronic illnesses [19]. In comparison to the general population, these individuals experience more challenging circumstances in terms of their overall health, financial situation, and housing condition [19]. Individuals suffering from one or more chronic diseases also face increased financial challenges compared to patients without such conditions [29]. Chronically ill patients are thus not only complex due to their chronic disease burden, but also because of the often-present concurrent financial issues. If social workers would address the financial issues, GPs could utilize the consultation time to address the medical concerns of chronically ill patients, rather than dealing with the patients’ financial problems. A low-barrier referral to a social counselling service for professional support for these patients is therefore of paramount importance.

Social isolation and loneliness are prevalent, particularly among older individuals. They are associated with a heightened risk of heart disease, stroke, type 2 diabetes, depression, and other illnesses [30]. However, social isolation and loneliness are a multifaceted and complex phenomenon. Social counselling provides far greater opportunities than GPs to reintegrate lonely individuals into the community and promote their social engagement [31]. A low-threshold referral to social workers would also be of immense importance in this context. These are just two examples, yet they emphasize the tremendous importance of effective collaboration between GPs and social workers.

In terms of collaboration between GPs and social workers, our findings revealed that GPs perceive rare contact with social workers, whereas social workers report slightly more frequent contact. Both groups expressed a desire for increased contact and cooperation. GPs perceived a high demand for increased contact and expressed a preference for direct communication. When queried about the benefits of such contact, they highlighted enhanced quality of care, improved mental health, and increased patient autonomy. A systematic review conducted by McGregor et al. examined studies of social work interventions in primary care spanning from 1990 to 2015. The review concluded that although there was no conclusive evidence of effectiveness, the findings suggested a promising role for social work in general practice. These included improved health outcomes such as enhanced subjective health, functioning, and self-management, as well as reduced psychosocial morbidity and fewer barriers to treatment and health maintenance [32]. In the report by Rüegg et al. focusing on social work in general practice, GPs perceive social work to be highly beneficial in practice. They derive advantages not only for themselves (e.g. increased job satisfaction and additional time to address medical concerns during consultations), but also for their patient and economic efficacy of the practice. Every surveyed GP acknowledged that social counselling enhanced the quality of care [19]. When it comes to GPs’ need for assistance from social workers within the practice, GPs typically do not seek to dismiss patients with challenging or intricate social issues. Instead, they confront the limitations of their competence and expertise in their daily practice. Some doctors also find it challenging to navigate the network of social services. Consequently, they express a desire to establish contact with authorities and gain a better understanding of the “landscape of existing services” in general [19]. In light of this, there is a significant demand for collaboration between social workers and GPs, particularly through direct contact.

GPs and social workers surveyed in our study most commonly cited “difficult accessibility”, “lack of knowledge of each other’s possibilities”, and “lack of funding” as obstacles to cooperation. A German study concluded that a lack of knowledge about each other’s specific activities and time constraints played a more significant role than financial considerations [33]. Additionally, communication between GPs and social workers was often hindered by the medical jargon used by doctors or their limited availability. Another obstacle seems to be the individual complexity of certain patient issues and concerns about data privacy. When combined with time constraints, these factors made collaboration challenging [33]. Another German study by Kloppe et al. concluded that representatives from social care services identified the lack of adequate structures as the primary obstacle to professional collaboration [34]. However, several other nations, including Canada [35], Ireland [36], England [37], and New Zealand [38], seem to have largely overcome these obstacles by successfully establishing cooperation between social workers and GPs.

Concerning funding, in Switzerland the Swiss Health Insurance Act provides very limited opportunities for social counselling to be covered by compulsory basic insurance. For the few dedicated pioneers of social work in Swiss general practice, a compatibly high level of effort is required to secure funding [39]. Despite the desire for enhanced cooperation, many initiatives fail due to a lack of funding opportunities, including rejected foundation contributions, unclear billability, and critical inquiries from health insurance companies. Therefore, nearly all social workers providing their services in general practices are working on externally funded research projects. It would primarily be the responsibility of the cantons, municipalities, and the federal government to facilitate such efforts of interprofessional cooperation [40]. A study in 2019 conducted by the Bern University of Applied Sciences on behalf of the Federal Office of Public Health of Switzerland stated that concerning interprofessionality, many individual, organizational and social obstacles make it difficult to work together across the boundaries of one’s profession. The existing system is characterised in particular by a strong hierarchy across professions, a strict separation of areas of responsibility and rudimentary interface management. These facts currently stand in the way of successful interprofessional collaboration [41]. In terms of feasibility, however, small pilot projects show that cooperation is possible indeed. Since 2020, a non-governmental organisation called “Caritas beider Basel”, has been offering social counselling directly in medical practices in the cantons of Basel-Stadt and Baselland. Today, the service includes eight medical practices in general medicine, psychiatry, and paediatrics. The project is funded by foundations and self-payers and is scientifically supported by the Bern University of Applied Sciences [42]. In addition, the social counselling office “SoBü Bärn” is located in the canton of Bern. It has been operating since 2020 and accepts referrals from GP practices in the canton of Bern and surrounding areas [42].

The integration of social work into primary care is essential for a comprehensive, collaborative, and preventative approach to healthcare. By working more closely with social care professionals, GPs can address the social determinants of illness more effectively, leading to earlier interventions, targeted support, and more comprehensive treatment for patients. This collaborative approach not only optimises patient care but also enables the development of holistic solutions that incorporate both the medical and social dimensions. In addition, the opportunity for GPs to focus on their core healthcare tasks and the cost-effectiveness of integrated care present an attractive prospect to policymakers.

Strength and weaknesses

In Switzerland, there is currently limited data on the interprofessional collaboration between GPs and social workers, as well as on the prevalence of social issues in GPs’ consultations. This scarcity is exacerbated by inherent challenges in collecting data within the field of general practice and particularly among social work professionals [43]. A notable strength of the study lies in its capacity to deliver data on this subject. However, the study does possess certain limitations. Its cross-sectional design precludes the establishment of causal relationships and restricts the scope of statistical analyses. Additionally, the recruitment process presents shortcomings, as social workers and GPs were primarily sourced through specific networks (uniham-bb, Sentinella, SAGES), thereby limiting the generalizability of the findings. Response rates varied between social workers (5.5%) and GPs (28.4%). Email surveys typically report response rates between 5–15%, so the rather low response rates of social workers in our study are still within the expected range [44]. The response rates of GPs were higher and comparable to those reported by Bonevski et al. [45] In the Sentinella sample, GPs were recruited from across Switzerland, representing various language regions. In contrast, in the uniham-bb sample, recruitment was limited to the German-speaking region of north-western Switzerland, slightly overrepresenting the German-speaking GP population. The Swiss Sentinella network is considered representative of Switzerland’s primary care landscape [46]. Since the Sentinella sample forms the larger proportion of GPs in the study (82 vs. 61), some generalizability can be concluded for this group. In contrast, social workers were only recruited from German-speaking regions of Switzerland, meaning the results are generalizable only to this population. Additionally, the study’s relatively small sample size limits its generalizability to the entire population of GPs and social workers in Switzerland. Thus, while the findings offer valuable insights, they should be applied with caution to other regions or populations, with greater generalizability in German-speaking regions.

Conclusion

Social problems in general practice are very common, but the interprofessional cooperation between GPs and social workers in Switzerland is self-assessed as insufficient. However, both parties appear to be in favour of a closer interprofessional collaboration and seem to be willing to attempt to improve a joint patient care in the future. Integrating social workers into general practice may have the potential to foster a comprehensive, interprofessional, and preventative approach to patient care, contributing to improved healthcare outcomes. By working more closely with social care professionals, GPs can address the social determinants of illness more effectively, provide earlier interventions in this field, make more targeted social support available, and thus offer more comprehensive treatment for patients. In Switzerland, a lot of effort is still needed to realise appropriate support for patients regarding the improvement of their social issues on a large scale. Further studies are necessary to determine effective ways to facilitate collaboration between GPs and social workers.

Data availability

The datasets used and analysed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

GP:

General Practitioner

References

  1. Schroeder SA. Shattuck Lecture. We can do better-improving the health of the American people. N Engl J Med. 2007;357(12):1221–8.

    Article  PubMed  CAS  Google Scholar 

  2. Kaplan GA, Shema SJ, Leite CMA. Socioeconomic determinants of psychological well-being: the role of income, income change, and income sources during the course of 29 years. Ann Epidemiol. 2008;18(7):531–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Novilla MLB, Goates MC, Leffler T, et al. Integrating social care into healthcare: a review on applying the social determinants of health in clinical settings. Int J Environ Res Public Health. 2023;20(19):6873.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129(2):19–31.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Stringhini S, Carmeli C, Jokela M, et al. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet. 2017;389(10075):1229–37.

    Article  PubMed  PubMed Central  Google Scholar 

  6. McNamara CL, Balaj M, Thomson KH, Eikemo TA, Solheim EF, Bambra C. The socioeconomic distribution of non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health. Eur J Public Health. 2017;27(suppl_1):22–6.

    Article  PubMed  Google Scholar 

  7. Alegría M, NeMoyer A, Falgàs Bagué I, Wang Y, Alvarez K. Social determinants of mental health: where we are and where we need to go. Curr Psychiatry Rep. 2018;20(11):95.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Von dem Knesebeck O, Scherer M, Van den Bussche H, Schäfer I. Zusammenhang von sozialem Status und Multimorbidität. Hamb Arztebl. 2015;06:12–5.

    Google Scholar 

  9. Perna L, Thien-Seitz U, Ladwig KH, Meisinger C, Mielck A. Socio-economic differences in life expectancy among persons with diabetes mellitus or myocardial infarction: results from the German MONICA/KORA study. BMC Public Health. 2010;10(1):135.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lu J, Yu Z, Zhang X, et al. Association between social health status and health-related quality of life among community-dwelling elderly in Zhejiang. Health Qual Life Outcomes. 2020;18(1):110.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ziaei S, Hammarström A. What social determinants outside paid work are related to development of mental health during life? An integrative review of results from the Northern Swedish Cohort. BMC Public Health. 2021;21(1):2190.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jobst D, Joos S. Patients’ social problems - A survey in family practices. Z Allgemeinmed. 2014;90:496–501.

    Google Scholar 

  13. Rheumaliga Bern und Oberwallis. Sozialberatung. https://www.rheumaliga.ch/be. [05/04/2024].

  14. Lungenliga. Sozialberatung. https://www.lungenliga.ch/lungenliga-zentralschweiz/sozialberatung. [05/04/2024].

  15. Jobst D, Fuchs A, Joest A, Nagel N. Needs and wishes of healthy patients - how should physicians deal with them? Gesundheitswesen. 2007;69(11):607–11.

    Article  PubMed  CAS  Google Scholar 

  16. Schmitz C, Atzeni G, Berchtold P. Interprofessionelle Zusammenarbeit in der Gesundheitsversorgung: Erfolgskritische Dimensionen und Fördermassnahmen. Swiss Academies Communications. 2020;15(2).

  17. Schweizer Eidgenossenschaft. Gesundheitssystem. https://www.eda.admin.ch/aboutswitzerland/de/home/wirtschaft/soziale-aspekte/gesundheitssystem.html#:~:text=Das%20Schweizer%20Gesundheitswesen%20ist%20föderalistisch,und%20Einwohner%20der%20Schweiz%20obligatorisch. [22-10-2024].

  18. Dienststelle für Statistik. Finanzierungsstruktur des Gesundheitswesens. https://statistik.tg.ch/themen-und-daten/soziales-und-gesundheit/gesundheit/finanzierungsstruktur-des-gesundheitswesens.html/6963#:~:text=Die%20Kosten%20im%20Gesundheitswesen%20werden,bei%20der%20obligatorischen%20Krankenversicherung%20liegt. [22–10–2024].

  19. Rüegg R, Eiler K, Schüpbach F, Gehrlach C. Soziale Arbeit in der Arztpraxis - Grundlagen und Umsetzung. 2022.

  20. Hosek M. Bessere Behandlung durch Sozialberatung in der Arztpraxis. Schweiz Ärztezeitung: Published online; 2020.

    Google Scholar 

  21. Bundesamt für Gesundheit. Das Sentinella-Meldesystem. https://www.sentinella.ch/de/info. Accessed 02 May 2024.

  22. Universität Basel. Universitäres Zentrum für Hausarztmedizin beider Basel. https://hausarzt.medizin.unibas.ch/de/. Accessed 02 May 2024.

  23. Schweizerischer Fachverband Soziale Arbeit im Gesundheitswesen. https://www.sages.ch/Accessed 02 Febr 2024.

  24. Zimmermann T, Mews C, Kloppe T, et al. Soziale Probleme in der hausärztlichen Versorgung – Häufigkeit, Reaktionen, Handlungsoptionen und erwünschter Unterstützungsbedarf aus der Sicht von Hausärztinnen und Hausärzten. Z Evid Fortbild Qual Gesundhwes. 2018;131–132:81–9.

    Article  PubMed  Google Scholar 

  25. Primary Health Care Classification Consortium. International Classification of Primary Care (ICPC). http://www.ph3c.org/4daction/w3_CatVisu/en/icpc.html?wCatIDAdmin=1106Accessed 03 Feb 2024.

  26. International Statistical Classification of Diseases and Related Health Problems 10th Revision. https://icd.who.int/browse10/2019/en. Accessed 29 Apr 2024.

  27. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2023. https://www.Rproject.org/.

  28. Bikson K, McGuire J, Blue-Howells J, Seldin-Sommer L. Psychosocial problems in primary care: patient and provider perceptions. Soc Work Health Care. 2009;48(8):736–49.

    Article  PubMed  Google Scholar 

  29. Becker NV, Scott JW, Moniz MH, Carlton EF, Ayanian JZ. Association of Chronic Disease With Patient Financial Outcomes Among Commercially Insured Adults. JAMA Intern Med. 2022;182(10):1044–51.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Centers for Disease Controll and Prevention. Health Risks of Social Isolation and loneliness. https://www.cdc.gov/emotional-wellbeing/social-connectedness/loneliness.htm#:~:text=Social%20isolation%20and%20loneliness%20have%20been%20linked%20to%20increased%20risk%20for%3A&text=Heart%20disease%20and%20stroke.,Depression%20and%20anxiety. [24/02/2024].

  31. Heilsarmee. Einsamkeit, Teilhabe und Inklusion. https://heilsarmee.ch/themen-angebote/einsamkeit-teilhabe-inklusion/ [13/03/2024].

  32. McGregor J, Mercer SW, Harris FM. Health benefits of primary care social work for adults with complex health and social needs: a systematic review. Health Soc Care Community. 2018;26(1):1–13.

    Article  PubMed  Google Scholar 

  33. Jobst D, Büscher I. Family medicine and social-work together, but how?: Results from two qualitative surveys. Z Allgemeinmed. Published online 2024;100:1–6.

  34. Kloppe T, Tetzlaff B, Mews C, Zimmermann T, Scherer M. Interprofessional collaboration to support patients with social problems in general practice—a qualitative focus group study. BMC Primary Care. 2022;23(1):1–15.

    Article  Google Scholar 

  35. Alderwick H DJ. The NHS longterm plan. BMJ. 2019;364.

  36. Fleming T, Flood S, Gumulka S, Jacob D, Parkinson R. The Role of Social Work in Primary Care in Ireland. Published online 2011:1–20.

  37. Selhi N. Gateway Community Health Centre Counselling 2021. www.gatewaychc.org/counselling/.

  38. Döbl S, Huggard P, Beddoe L. A hidden jewel: social work in primary health care practice in Aotearoa New Zealand. J Prim Health Care. 2015;7(4):333–8.

    Article  PubMed  Google Scholar 

  39. Rüegg, René, Eiler, Katharina, Schüpbach Fabienne GC. Soziale Arbeit in der Arztpraxis, Grundlagen und Umsetzung. Published online 2022.

  40. Rüegg R. Sozialarbeit ist Gesundheitsarbeit. Neue Zürcher Zeitung.

  41. Gurtner S, Wettstein M. Interprofessionelle Zusammenarbeit im Gesundheitswesen - Anreize und Hindernisse in der Berufsausübung. Berner Fachhochschule Departement Wirtschaft Institut Unternehmensentwicklung: Published online; 2019.

    Google Scholar 

  42. Wildisen L, Rüegg R. Sozialberatung in der ambulanten Versorgung : Wie klappts ? Published online 2024:20–21.

  43. Jungo KT, Lindemann F, Schwab N, Streit S. Mögliche Lösungen Für Auftretende Schwierigkeiten Hürden Und Chancen Der Klinischen Forschung in Der Hausarztmedizin. 19;2019.

  44. Alexander Eser. Average Survey Response Rates: From 1% by Mail to 60%. https://worldmetrics.org/average-survey-response-rate/. [12-11-2024].

  45. Bonevski B, Magin P, Horton G, Foster M, Girgis A. Response rates of GPs. Aust Fam Phys. 2011;40(6).

  46. Fritz RD, Merlo C, Essig S. How time consuming are general practitioners’ home visits? Insights from a cross-sectional study in Switzerland. Swiss Med Wkly. 2023;153(2):40038.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all participating GPs and social workers for contributing to this study. Thanks also to the Swiss College of General Practitioners (KHM) for the generous support. The KHM is an exchange and strategy platform for general practitioners and paediatricians aiming to play a key role in shaping the present and future of primary medical care in Switzerland and supporting research in general practice.

Funding

Open access funding provided by University of Basel This project was funded by the College for Family Medicine (KHM), Switzerland.

Author information

Authors and Affiliations

  1. Centre for Primary Health Care, University of Basel, Basel, Switzerland

    Tonia Gerber, Laura Diaz Hernandez & Andreas Zeller

  2. Bern University of Applied Sciences, Bern, Switzerland

    René Rüegg

  3. Caritas Basel Beider Basel, Basel, Switzerland

    Dunja Vetter

Authors
  1. Tonia Gerber
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Laura Diaz Hernandez
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. René Rüegg
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Dunja Vetter
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Andreas Zeller
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

TG conducted the survey, made the statistical analyses, and wrote the manuscript. TG conducted the survey, made the statistical analyses, and wrote the manuscript. RR reviewed the questionnaire, helped send the newsletters, and reviewed the manuscript. DV reviewed the questionnaire and the manuscript. LDH reviewed the manuscript. AZ prepared the questionnaire and reviewed the manuscript. RR reviewed the questionnaire, helped send the newsletters, and reviewed the manuscript. DV reviewed the questionnaire and the manuscript. LDH reviewed the manuscript. AZ prepared the questionnaire and reviewed the manuscript.

Corresponding author

Correspondence to Tonia Gerber.

Ethics declarations

Ethics approval and consent to participate

All methods were carried out in accordance with relevant guidelines and regulations, specifically following the Declaration of Helsinki. Ethical approval of the study was sought from the Ethics Committee of Northwest and Central Switzerland (EKNZ). The committee advised that formal ethical approval was not required (Project ID: Req-2022–01101), as the survey complies with the general ethical principles for human research. Participants provided informed consent by agreeing to participate in the survey.

Consent for publication

Consent for publication was tacitly assumed upon completion of the questionnaire.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gerber, T., Hernandez, L.D., Rüegg, R. et al. Social issues in general practice – a survey assessing the interprofessional perspective of general practitioners and social workers regarding frequency, challenges, and needs. BMC Prim. Care 26, 11 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12875-024-02702-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12875-024-02702-z

Keywords

BMC Primary Care

ISSN: 2731-4553

Contact us