Rent arrears do not disappear when a patient enters a GP surgery. Neither does the insecurity of a disputed benefit claim. These problems arrive alongside illness; the institutions responsible for addressing them remain elsewhere. The patient must somehow assemble a response from services organised around boundaries their life does not respect.
Putting welfare advisers or legal services inside primary care offers a practical response. It also raises a political question: can healthcare help restore access to social protection, or will it become the place where an increasingly inadequate welfare state deposits its consequences?
Our recently published umbrella review, led by Helena Painter, brings this question into focus. , we examined co-located services supporting disadvantaged groups in primary care. The 13 reviews drew upon evidence from high-income countries, predominantly the UK and USA. This article primarily addresses UK policy; its wider relevance concerns how welfare states organise access to support. Applying these findings elsewhere requires attention to differences in healthcare, legal and social security systems. Overall, the findings suggest opportunities to improve access and social circumstances; they also expose the limits of treating service organisation as a substitute for social policy.
Rights that people can actually reach
Co-location means delivering distinct services in the same physical space. In our review, these included welfare advice, legal assistance and complementary healthcare, particularly mental health services. Their significance extends beyond convenience.
A referral assumes that someone can follow it. That requires knowing whom to contact, understanding what is being offered and finding the time or strength to pursue it. For people already contending with illness and financial insecurity, another address can become another point at which assistance falls away.
The international review by Sarah Beardon and colleagues found that health-justice partnerships reached people who would otherwise have been unlikely to seek legal assistance. Familiarity with the healthcare setting, confidentiality and trust in clinicians helped people accept support. Bringing an adviser into that setting can therefore change who receives help, as well as where it is delivered.
This matters for the meaning of entitlement. A right that requires considerable confidence and persistence to exercise will be least accessible to some of those who need it most. Co-location can reduce that burden by making identification and practical assistance part of an existing relationship.
The gains can be material. Sian Reece and colleagues’ review of UK services reported improvements in financial circumstances; our synthesis also identified benefits relating to housing and knowledge of welfare rights. These are outcomes with a direct bearing on people’s lives, even before a health service attempts to translate them into clinical measures.
The temptation to count savings first
There is also evidence of improvements in mental health and wellbeing. David Young and Geoff Bates found their greatest confidence in the evidence concerning mental health and stress, while stressing the limitations of the wider evidence base. Across our review, interventions and study designs varied considerably. Promising findings should guide investment and evaluation; they cannot establish that every co-located service will produce the same benefits.
Nor can they justify a confident promise of NHS savings. Findings on healthcare use and efficiency were inconsistent. Better identification of unmet need may increase consultations or treatment. For someone previously excluded from care, that increase may be precisely what a successful service should achieve.
There is a political choice in deciding what counts as success. If advice must justify itself primarily by keeping people away from healthcare, its purpose becomes subordinate to demand management. Securing income, resolving a housing problem or enabling someone to obtain treatment should count in their own right. Public services exist to meet needs; their evaluation must allow us to recognise when previously unmet needs have become visible.
Integration requires more than a building
England’s 2025 Ten Year Health Plan proposes neighbourhood health centres bringing together NHS, local authority and voluntary services, including debt advice and employment support. Our findings offer support for the direction of travel. They also suggest that announcing a shared address is the easiest part.
Research in East London by Mirza Lalani and Martin Marshall found that co-location could improve communication and working relationships, but depended on conditions including shared systems and an understanding of professional responsibilities. A welfare adviser and a clinician can occupy neighbouring rooms while remaining separated by incompatible processes, uncertain funding and referral arrangements that nobody has time to maintain.
Investment must therefore cover the work that connects services. Commissioners should agree responsibilities and provide stable funding for advice, while preserving its independence. Patients need confidential spaces and accessible communication. Decisions about location must protect the continuity and local relationships that make primary care a trusted point of contact.
Equity also needs testing. Our review identified examples in which co-located services did not benefit all groups equally. Improving outcomes among disadvantaged participants does not, by itself, demonstrate that a population inequality has narrowed. Evaluation should ask who receives support, whose problems are resolved and who remains outside the service.
How much can primary care repair?
The deeper question concerns what government expects these services to repair. Independent advice can help someone obtain an entitlement or challenge a decision. It cannot make an inadequate entitlement sufficient, supply an affordable home where none exists, or remove the insecurity that repeatedly generates the need for assistance.
Co-location becomes politically convenient if its achievements allow those wider failures to escape scrutiny. A successful advice service can relieve hardship while leaving the policies producing it intact. Clinicians and advisers then inherit an expanding responsibility to manage consequences over which they have little control.
There is another possibility. Patterns emerging from shared casework can inform challenges to harmful policies; Beardon and colleagues identified examples of partnerships contributing to legal and policy change. Commissioners should support that function alongside individual assistance, and preserve access to advice outside healthcare so that social rights do not depend on becoming a patient.
Co-located services deserve investment because people should be able to obtain help without stitching together a fragmented state. Their success should also bring responsibility back to the institutions that shape income, housing and access to justice. Otherwise, primary care will be asked to make hardship more manageable while government leaves its causes in place.
Author biography
Dr Jatinder Hayre is a medical doctor and public health researcher; working on health inequities and the social determinants of health. He is a co-author of the umbrella review discussed here.
Suggested keywords: co-located services; primary care; welfare state; welfare rights advice; health inequalities; neighbourhood health centres.