Kate Langford, Programme Manager, Guy's and St Thomas' Charity
Nov 02, 2018
Over the past few years the idea of social prescribing has gone from the margins to the mainstream. Take Secretary of State for Health and Social Care, Matt Hancock's new prevention plan for example, following on from this year’s NHS expo where he spoke of making social prescribing a top priority:
"The evidence increasingly shows that activities like social clubs, art, ballroom dancing and gardening can be more effective than medicines for some people and I want to see an increase in that sort of social prescribing."
The idea of social prescribing is deceptively simple. People’s health issues often have social as well as biological causes, and therefore the support given to them should be both social and medical. As well as prescribing medicines where needed, GPs help direct their patients to community activities and groups that could improve their health and wellbeing.
From our work in Lambeth and Southwark we think social prescribing is a step in the right direction. Through our work and recent research into multiple long-term conditions, we have seen how community activities and groups help people like Jacqueline to build social connections, confidence and regain a sense of purpose in their life:
“Coming to Tea Break Theatre has saved my life. I would advise any patient that has problems like I have, come here and you will see the changes. You won't see it in one day or two days, you have to keep coming.”
We’ve also heard stories like Dr Raj Mitra’s, Lambeth CCG’s Social Prescribing lead and a GP at Lambeth Walk Practice. Dr Mitra has been spearheading social prescribing in Lambeth for over two decades, and said in a short film below that by providing a different type of support, his patients need to see him less.
However, we have also heard how the current patchwork of social prescribing activity isn’t working. For voluntary and community sector organisations it can mean a rapid increase in demand for their support, with no financial compensation. For GPs and healthcare professionals it can be challenging to understand the local resources to refer people to, despite the numerous directories which have been compiled – but then quickly gone out of date.
For people who need help, the fragmented nature of the current social prescribing landscape means that you might only benefit from it if you see a certain GP, live in a certain ward or are a certain age.
We’ve seen locally that making social prescribing work at scale is challenging. From the work our local partners have done we think there are three key shifts we need to think about if social prescribing is to benefit more people.
First, we think we need to move beyond thinking of social prescribing as a ‘one-size-fits-all’ service and start thinking about an ecosystem of social prescribing-like activities that can meet the needs of different types of people. For example, at Guy’s and St Thomas’ Charity we are primarily interested in social prescribing to slow down progression to multiple long-term conditions. This means we have to think about whether social prescribing could be impactful for working age people who might have one or two long term conditions, and what type of social prescribing might be desirable for this age group. This could mean looking beyond the GP referral model to employer-based social prescribing and wellbeing programmes, community connector schemes or even consumer digital platforms. For instance, in Lambeth, Project Smith trains community members to connect other people in their community to activities and resources that could improve their health.
Second, we need to think about a shift from short-term pilots to longer-term, sustainable funding.
Both locally and nationally the elephant in the room is that commissioners often talk about social prescribing as a way to save money, while community and voluntary sector partners see it as a potential income source.
Given the state of public finances, we need to look beyond the public sector as the sole funder of social prescribing. We’re interested in exploring a mixed model of funding where public sector funding, grants, trading activities and self-pay can all be combined to provide sustained funding for social prescribing activities. For example, Ways to Wellness in Newcastle is funded through a combination of social investment, grants and public sector funding.
Finally, we need to stop thinking about this as just something that GPs need to do. GPs are important, but there are many other healthcare professionals who are and could be having social prescribing conversations with patients. For example, Guy’s and St Thomas’ NHS Foundation Trust are currently piloting a new team called “High Intensity Users” where a specially trained team reach out to the most frequent attenders of accident and emergency and work with these people to understand the root causes of their visits, connecting them up to resources to support them.
Social prescribing could and should be something that every healthcare professional has in their toolbox, but this will require a huge shift in culture and practice.
As part of our work to slow the progression from one to many long-term conditions, we’re working with local partners including the Lambeth and Southwark Local Care Networks and voluntary sector organisations to help us understand what it would take to scale the impact of social prescribing. We’re continuing to explore how we, as a funder, could best support our local partners to help tackle multiple long-term conditions in our boroughs. Find out more about our programme here.
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