GPs prescribing more than drugs
Social prescribing, sometimes referred to as community referral, is a way of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.
Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.
Social prescribing schemes can involve a variety of activities which are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports.
There are many different models for social prescribing, but most involve a link worker or navigator who works with people to access local sources of support. The Bromley by Bow Centre in London is one of the oldest and best-known social prescribing projects. Staff at the Centre work with patients, often over several sessions, to help them get involved in more than 30 local services ranging from swimming lessons to legal advice.
Social prescribing is designed to support people with a wide range of social, emotional or practical needs, and many schemes are focused on improving mental health and physical well-being. Those who could benefit from social prescribing schemes include people with mild or long-term mental health problems, vulnerable groups, people who are socially isolated, and those who frequently attend either primary or secondary health care.
£4.5 million funding
The reason for writing this post today is the recent (23 July 2018) announcement by the Department of Health and Social Care of £4.5 million to fund 23 social prescribing projects across England. It’s no surprise that government wants to fund this approach. Evidence shows that social prescribing can reduce demand on NHS services: a UK study found that after 3 to 4 months, 80% of patients referred to a social prescribing scheme had reduced their use of A&E, outpatient appointments and inpatient admissions.
The 23 projects funded are wide-ranging but include:
People Potential Possibilities (P3)
This Milton Keynes scheme aims to build on an existing small service for high-intensity users of NHS and emergency health medical services, as well as police custody suites. The new part of the scheme aims to reduce demand from GPs by working with people of medium to lower needs. People who may benefit include those who have complex or entrenched needs requiring multiple services and solutions to address underlying issues such as:
- social isolation
- substance misuse
- financial and debt issues.
Solutions include linking people to local groups, activities and new hobbies. Individuals will have support tailored to their needs ranging from very regular, intensive, support to single-contact interventions.
This new social prescribing scheme will cover a large number of GP practices across Birmingham, providing around 400,000 residents access to a social prescribing system. The model will include access to ‘community link workers’ as well as a ‘digital hub’ and wellbeing plan to help address health and wellbeing issues in the community.
Charlton Athletic Community Trust
The scheme aims to expand an existing pilot scheme based in Greenwich from 7 GP surgeries into a further 10 localities. The scheme mostly focuses on adults who have visited their GP on 12 or more occasions in the previous year and on helping individuals to better manage their health.
Does social prescribing work?
The King’s Fund summarised the recent evidence about social prescribing, reproduced below:
There is emerging evidence that social prescribing can lead to a range of positive health and well-being outcomes. Studies have pointed to improvements in areas such as quality of life and emotional wellbeing, mental and general wellbeing, and levels of depression and anxiety. For example, a study into a social prescribing project in Bristol found improvements in anxiety levels and in feelings about general health and quality of life. In general, social prescribing schemes appear to result in high levels of satisfaction from participants, primary care professionals and commissioners.
Social prescribing schemes may also lead to a reduction in the use of NHS services. A study of a scheme in Rotherham (a liaison service helping patients access support from more than 20 voluntary and community sector organisations), showed that for more than 8 in 10 patients referred to the scheme who were followed up three to four months later, there were reductions in NHS use in terms of accident and emergency (A&E) attendance, outpatient appointments and inpatient admissions. The Bristol study also showed reductions in general practice attendance rates for most people who had received the social prescription.
However, robust and systematic evidence on the effectiveness of social prescribing is very limited. Many studies are small scale, do not have a control group, focus on progress rather than outcomes, or relate to individual interventions rather than the social prescribing model. Much of the evidence available is qualitative, and relies on self-reported outcomes. Researchers have also highlighted the challenges of measuring the outcomes of complex interventions, or making meaningful comparisons between very different schemes.
Determining the cost, resource implications and cost effectiveness of social prescribing is particularly difficult. The Bristol study found that positive health and wellbeing outcomes came at a higher cost than routine GP care over the period of a year, but other research has highlighted the importance of looking at cost effectiveness over a longer period of time. Exploratory economic analysis of the Rotherham scheme, for example, suggested that the scheme could pay for itself over 18–24 months in terms of reduced NHS use.
Several studies highlight the importance of measuring the wider social value generated through social prescribing, for example through reducing welfare benefit claims. Again, this can be difficult to measure, and may require a longer- term approach.