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How can social prescribing help practices?

What is social prescribing and can it help practices to reduce their workload? Greg Pitcher reports.

Schemes that tackle isolation and loneliness have helped reduce surgery attendance
Schemes that tackle isolation and loneliness have helped reduce surgery attendance

A year has passed since health secretary Jeremy Hunt called for social prescribing to become as normal for GPs as authorising pills.

In that time a dedicated network for the activity has sprung up and NHS England has said it will appoint a national champion for social prescribing. In the General Practice Forward View NHS England said social prescribing is ‘a key measure by which patients can benefit from wider support’.

What is social prescribing?

So what exactly is social prescribing, and how can practices benefit from it?

According to a report published by the Social Prescribing Network earlier this year, social prescribing ‘acknowledges the need for patients to access non-clinical resources to enable them to improve their health and wellbeing’.

The report adds that social prescribing can connect GP practices with ‘the voluntary groups, the services designed by the social prescribing organisations, the housing provider, the children’s centre, the timebank, the faith organisations, the police and so on’.

Last year Jeremy Hunt said that GPs spend one in every five hours dealing with patients’ social problems – citing debt, housing and relationship issues as among those brought in to surgeries.

Social prescribing aims to provide an effective route from such non-medical consultations to community groups that can help, aiding the patient and freeing up GP time.

Tim Anfilogoff worked for 20 years in social care, and at the start of this decade helped set up HertsHelp – a service that has a single telephone number but brings together community and voluntary services in the county.

The idea came after a conference where delegates were split into groups and given hypothetical patients with non-medical problems to solve.

‘They all got about 85% through solving them, but when we got everyone back together there was always someone in the room who could complete the solution,' he says. 'This proved that the information existed but not the network.'

To encourage GPs to use the service, prescription pads were made with the HertsHelp phone number, and electronic referral systems created.

Mr Anfilogoff has since been seconded to Herts Valleys CCG as integration lead clinician. He runs a small team of community navigators, who help identify which services could help individual patients.

‘HertsHelp calls the patient and if necessary a community navigator will go to the patient and spend 90 minutes to identify the underlying problem,’ he says.

Practice-approach to social prescribing

In Liverpool, a practice has taken a much smaller-scale, hands-on approach to social prescribing.

Practice manager Deepa Gnanasundaram says the story began for Storrsdale Medical Centre more than two years ago when practitioners noted a number of calls from elderly people they felt unable to help.

After discussions internally and with charity Contact The Elderly the practice decided to hold tea parties for isolated patients.

‘We hold the tea parties in the surgery,’ says Ms Gnanasundaram. ‘It’s local and not an alien environment. We advertised in the practice and some patients volunteered to bake or help out in other ways, as did every member of staff. We started with six patients one Sunday a month and now we have 15, recommended by the clinician.

‘We make it exciting, there’s a lively atmosphere. We wore masks at Halloween and there were tears when we gave them hampers at Christmas. These are lonely people and we made them happy.’

There are direct benefits to the patients and the practice.

‘The patients speak to the GP casually at the event rather than through a consultation and I find patients do not attend hospital as much,’ says Ms Gnanasundaram.

‘Fundamentally, the benefits are more than the cost. We have had letters congratulating us. The list size has gone up by word of mouth. We spend more time and effort but in the right place I think.’

Benefits of social prescribing

Social Prescribing Network co-chair and senior lecturer and the University of Westminster Dr Marie Polley says work is underway to define the benefits from social prescribing to the health service as a whole.

‘Services have seen positive patient outcomes such as weight loss and reductions in anxiety,’ she says. ‘We conducted a survey of 200 patients and found a reduction in isolation. If you increase social connections people start functioning.

‘From an economic point of view we are seeing a return on the investment in costs within two years – within a year if you look at the broader public purse, including welfare payments and so on.

‘Some practices have increased their practice lists and make more money that way. You can decrease your waiting list at the same time and increase the length of time people have with their GP.’

‘Link workers’

The so-called ‘link workers’ are key to making social prescribing work – they need to know communities well and be able to work closely with patients referred by the GP to ease them into activities that could help.

‘At the moment funding for link staff is coming from trusts and charities – practices have found money wherever they can,’ says Dr Polley.

‘The link worker could come from various professions, as long as they have level 4 qualifications. It could be a health assistant. In one case I know a health advisor has a background in rehabilitation and motivational interviewing so is good at listening to barriers and finding solutions.

‘With a properly defined referral pathway you can say to someone "go and see our link worker" and this person has up to an hour with the patient to see what kind of lifestyle changes they need.’

Advice for practices

The Social Prescribing Network is developing resources to help practices that are interested in social prescribing.

‘We are working with NHS England to define referral pathways and on a toolkit to define good social prescribing practice,’ says Dr Polley. ‘We hold regional networking days and put on events to bring professional together.’

Devon GP and Social Prescribing Network co-chair Dr Michael Dixon believes social prescribing will be standard practice in years to come.

‘The network's role is to provide practical and moral encouragement, generate evidence and spread the word,’ he says. ‘Within 20 years this will be a standard model of care. Every practice will have a link person or refer to a hub. It should be universally obtainable.

‘It will be a net benefit – costs, such as for A&E referrals, will go down. It will also stop the eternal frustration where a prescription pad won’t solve a patient’s problem.’

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