Pills and pottery, music and MRIs – why and how is social prescribing a valuable tool?
Reda Misghina, Analyst
What if a patient with asthma comes to their GP repeatedly complaining about their household mould? With the right interventions the GP can keep the respiratory condition in check, but who can help the patient deal with the damp? Household dampness may even work against the efforts of the GP, despite the clinical intervention. What if this patient doesn’t know that they can receive assistance from other services? Surely, someone out there knows of the vast array of services that could help this person?
Social prescribing can feel like a new buzz word for commissioners and providers within our NHS. In fact, the practice of social prescribing has been running for a few years now, with the first traces dating to 1984 with the Bromley by Bow Centre.1 Social prescribing enables healthcare professionals to refer patients to a Link Worker who can co-design a non-clinical2 social prescription to improve their health and wellbeing.3 It aims to link people with sources of support present within the voluntary and community sector organisations (VCSO). Social prescribing works alongside medical intervention but is aimed at social and emotional factors associated with medical conditions.
It is designed for, but not limited to, people with long-term conditions, for those who are socially isolated or those who frequently attend health services.4 Usually, a clinician makes a referral to a Link Worker who does an in-depth assessment with the person on the root cause of the issue. The practitioner will then refer them to an appropriate service found in the community that can help a person in a more holistic and impactful way. The aim is to enable people to make lasting changes to their health and wellbeing by encouraging self-care and self-management by responding to the physical, emotional and mental state of a person rather than their physical health alone.
Each social prescribing service available in England has a different model, as each responds to different set of needs and challenges unique to their area. While the Rotherham model5 focuses on helping those with existing long-term conditions, the Bromley-by-Bow6 model is tailored to support all adults who present to primary care with non-medical issues. Whichever model is applied, the main aim of social prescribing is not about, for example, giving anti-depressants to a person suffering from depression and stopping there. It goes the extra mile by looking at the physical and mental problem with a long-term aim to help the person out of their current state. Encouraging a person to do these activities on their own requires time. Currently, a GP, even if willing, does not have the time to explore other related problems. Therefore, the ability to connect with a Link Worker and, by extension, with wider services offers a different route to resolving non-medical issues.
NHS England have announced initial recruitment of 1,000 Link Workers to support the Primary Care Networks (PCNs) developing in England serving natural communities ranging from 30,000 to 50,000 people.7 The new GP Contract Framework8, released in late January 2019, specifies that new funding is being made available for every PCN in England to recruit one Link Worker per network. This, for many VCSOs will be great news and I am sure it is being welcomed with enthusiasm and commitment. As one organisation that uses gardening as a form of therapy to improve people’s mental and physical health put it, “up to now referrals to gardening and other nature-based activities have not been forthcoming to any significant degree on a national scale, but today’s announcement of a new five-year GP contract brings the promise of funding that aims to change this.”9
Currently, PPL is working with a client who is interested in setting up a social prescribing service within these PCNs. With the fresh appetite created by NHS England’s announcement, we are using best practice from around the country to build a new model of care. During this piece of work, a few key points and risks have been made evident and these must be considered in conjunction to the funding released by NHSE.
Firstly, workforce is an important element. The funding only covers one-full time Link Worker per network and does not consider project management and other overheads necessary. It may also result that PCNs that are within a geographically defined area decide to cooperate, rendering management of the service even more important. If this is the case, the PCNs will benefit from sharing admin costs necessary to make social prescribing an effective tool.
Secondly, the focus on increasing referrals to the VCSOs will mean that these groups will experience an increase in demand due to the influx of people using their service. This means that they will have to work harder to meet the demand created through social prescribing by providing more services or expanding their current capacity. The reality in some areas is that they are being asked to take on more people with complex needs and provide care for them, sometimes without adequate funding, support or training. It is recognised that the sector is already working hard with insufficient funding. Hence grassroot investment is needed to support community development to help with setting up new services, funding for new facilities and sustain already over-stretched activities. The voluntary sector will also need to start looking at new strategies and programmes that may help meet the unmet need that will likely be uncovered through social prescribing. Link Workers will need to forge new relationships and explore possible opportunities to create new services within the third sector. The NHSE guidance is less clear on the sort of support these small organisations will receive to meet this demand and more in-depth conversations need to take place, this time to explore other avenues to support these grassroot services.
Lastly, care of duty is being pushed outward from health services, sometimes without due regard to the related risks for people and providers. At what point does clinical care of duty end (from a clinician to a Link Worker) and responsibility transfer to a local organisation? Or will care of duty end at the point of referral from the clinician? There is a limit to what volunteers can and will do, despite the best of intentions.
These are some of the unanswered questions that may need to be clarified by guidelines if we are to expect the social prescribing service to work efficiently.
So, how might our asthma patient benefit from social prescribing? The Link Worker could encourage the person to engage with their landlord in a more productive way by linking them to a service that helps tenants and landlords. The service will work with the tenant and landlord to improve their housing conditions or give alternative advice to the person. If, during the session with the Link Worker, other issues are brought up, then a more holistic, person-centred assessment can take place. For example, encouraging the person to be more physically active. As a result, the person will not visit their GP for the same reason again, benefiting both primary care and the person.
- Bromley by Bow Centre website
- Non-clinical or non-medical means accepting that certain health conditions will have an accompanying non-medical element attached to them. It can go both ways: a health conditions deteriorating social or emotional factors or, social and emotional factors that bring about different health conditions. For more information: Social prescribing at a glance. Health Education England (2016).
- Social Prescribing Network. University of Westminster (2018).
- What is social prescribing? Kings Fund (2017).
- Rotherham Social Prescribing Service.
- Bromley by Bow General Social Prescribing
- NHS England unveils plans to recruit army of social prescribers. Pharmatimes (2019).
- GP Contract. NHS England (2019).
- Social Prescribing takes welcome step forward. Thrive (2019).