Social prescribing is now a firmly established primary care service that provides support and resources to patients in need. It’s an approach to health and social care that looks at the patient holistically, rather than at their medical or psychiatric condition. It is an alternative to traditional clinical practice and has been shown to provide benefits for patients who are challenged with complex needs. In 2017, the UK Government recommended social prescribing in response to the findings from an independent review of how the NHS works. Social prescribing aims to improve the balance between physical health, mental health, and social needs.
In the UK, social prescribing began with a pilot project run by the charity Action for Prisoners’ Families (APF) in 1998. This model was later expanded on by APF as part of its wider strategy for reducing reoffending rates among ex-prisoners. The NHS has since taken over as the leading provider of social prescription services across England and Wales. This began with the NHS Vanguard program, where health systems across the country tested different ways of working. Many of these changes were introduced to the wider system through the Primary Care Network Direct Enhanced Service Additional Roles Reimbursement Scheme. This scheme is specifically designed to layer additional team members over the existing complement so that they can do “different and more”. This rollout was initially disrupted by the pandemic, where all resource was redirected to the vaccination program, but many areas now have teams established and the wider system is starting to understand their role.
There is a wide range of social prescribing services – from those who offer a brief intervention and signpost to other statutory and voluntary and community services to dedicated services that regularly support patients to self-care.
‘An evaluation of a social prescribing project in Bristol from 2013 demonstrated improvements in anxiety levels and in feelings about general health and quality of life. And a study of a scheme in Rotherham (a liaison service helping people access support from more than 20 voluntary and community sector organisations), showed that for more than 8 in 10 people referred to the scheme who were followed up 3 to 4 months later, there were reductions in NHS use in terms of accident and emergency (A&E) attendance, outpatient appointments, and inpatient admissions. More recent evaluations have pointed to similar opportunities. A community connector scheme in Bradford reported improvements in service users’ health-related quality of life and social connectedness (among other measures). A programme in Shropshire, evaluated between 2017 and 2019, found that people reported statistically significant improvements in measures of well-being, patient activation, and loneliness. At three-month follow-up, it also found that GP consultations among participants were down 40 percent compared to a control group.’ (Information is taken from https://www.kingsfund.org.uk/publications/social-prescribing.)
Social prescribing has been proven to be a successful intervention that has an immediate impact on physical and mental health. It can also reduce the consumption of costly prescription medications and improve the well-being of patients by reducing social isolation, financial distress, and anxiety. It is a way for doctors to provide services efficiently and effectively by collaborating with other healthcare providers, such as social workers, nurses, pharmacists, and psychiatrists to provide tailored care. It is also a cost-effective way of providing medical treatment in the community. For example in the UK, 1 in 4 people suffer from mental illness but only 1 in 10 are prescribed medication for it.
Early schemes developed in General Practice, tended to lean towards traditional approaches. In some cases, “mock prescriptions” were created with several social resources. During a consultation, clinicians would identify the social resources that could be of use to the patient and “prescribed” them by ticking the box next to each one. These schemes still have their place for very brief interventions, but many have now grown in complexity embracing person-centred and motivational interviewing psychological therapies. Adopting these approaches allows patients to truly feel listened to and build their own ability to self-care, reducing dependency upon statutory services.
It is hard to believe that relatively simple interventions can have significant impacts on patients’ use of services. We worked with a VCSE to develop a social prescribing program using the spoken word – poetry. Over several weeks I witnessed a transformation of the individuals involved, they explain it in their own words here. These patients continue to support the program delivery, alongside the professional poets. It can take time to persuade the wider team of the value of social prescribing, it can also be challenging to define who would benefit. Telling the story of patient successes can be a very powerful way to join the dots.
Written by Xytal consultant Daniel Vincent.