Last reviewed 11 June 2018

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, stated: “Social prescribing is not a new idea — good GPs have always done it, it just didn’t have a name — but we need to start realising the wider, long-term benefits this way of working can have, for general practice, the wider NHS, and most importantly our patients.” Deborah Bellamy investigates.

According to Spotlight on the 10 High Impact Actions, a report by the Royal College of General Practitioners, (RCGP), GP surgeries should be funded for a dedicated social prescriber to help tackle GP workload issues. Workload in general practice increased by at least 16% between 2007 and 2014 and is set to increase further.

What is social prescribing?

The Kings Fund defines social prescribing, sometimes also referred to as community referral or signposting, as a way of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.

The health of individuals is influenced by social, economic and environmental factors and social prescribing strives to address needs in a holistic way, supporting and enabling more control of their own health.

A social prescription may offer a range of activities including: community gardening, cooking clubs, debt management workshops, housing advice, career coaching, gym classes, walking groups, art or creative classes, volunteering, choirs or help writing a CV.

What does it mean for patients?

Social prescribing means finding something relevant to the patient enabling them to move forward to the next stage in their health life with targeted support focused on improved mental health and physical wellbeing feeling empowered to move forward.

Patients likely to benefit from social prescribing schemes are those suffering with complex social, emotional or practical needs, mild or long-term mental health problems, vulnerable groups, those who are socially isolated or frequently present in either primary or secondary healthcare settings.

Releasing time for care programme

The RCGP report assesses NHS England’s Releasing Time for Care Programme which has received some criticism with perceived limitations of its aim to reduce workload in general practice. Of the 10 High Impact Actions evaluated by the RCGP, the recommendation to utilise social prescribing is the one deemed likely to be most effective and mutually beneficial for Primary Health Care Teams and patients.

Is there any evidence this is likely to work?

A study published in BMJ Open, reported social prescribing by a trained link worker as an efficient way to improve the health and wellbeing of patients with chronic diseases such as: asthma, cardiovascular disease, diabetes, epilepsy, and osteoporosis, which may coexist alongside symptoms of anxiety and/or depression. An evidence review from the University of Westminster backed this up with findings of an average reduction of 28% in demand on GP services following a referral to a social prescribing service. In addition, an RCGP survey revealed that 59% of GPs felt social prescribing could support workload reduction.

A report by the work foundation suggested that despite some individuals being interested in returning to work, it was rarely identified as a priority goal at the assessment stage of social prescribing; referrals specific to work services such as support with CVs, interview practice and job searches were rare compared to referral to other types of activities and services.

There is currently no specific NICE guideline relating to social prescribing, but they suggest many of their recommendations could arguably be referring to it, for example, the importance of having a point of referral for any practitioner who meets people in their own homes and finds they need some support of a more social nature.

What are the templates for social prescribing likely to look like?

There needs to be clarity about what social prescribing is hoping to achieve locally as patient needs and resources will vary greatly across the country.

There are different models for social prescribing, but most involve a link worker who works with people to access local sources of support.

Social prescribing mainly addresses four key areas.

  1. Physical health.

  2. Social isolation.

  3. Financial stressors.

  4. Psychological wellbeing.

The three elements to social prescribing are as follows.

  1. A healthcare prescriber.

  2. A non-clinical link worker or social facilitator providing the pivotal role to identify patient’s individual challenges, obstructions and interests.

  3. A range of local voluntary, community and social enterprise groups to which a person can be referred.

The voluntary and community sector provides a vast network of support that clinicians can signpost patients to. Yet, boundaries between the voluntary and health services mean such opportunity is rarely obvious.

In order to link patients into services that reflect their needs, the link worker in particular must have in depth knowledge of a wide range of services and activities available in their local community.

What fundamentally needs to happen?

A common language

The key will be creating a jargon-free design that is understandable and that can be implemented easily across the UK.

Sustainability

Funding is a problem for many practices but a successful grassroots movement of frontline practitioners working closely with NHS England and RCGP support may mean this is made a priority.

Social prescribing schemes have been funded in a variety of ways. Some have been through Clinical Commissioning Groups and/or local authority funding; others with public health money, grants and trusts.

Evidence of the successes will involve sharing data, business cases, successes and failures into the mainstream. Increased information is needed for social prescribing based on a common evaluation framework, support for people to develop services and a three-year funding programme to allow for a planning cycle.

Essential ingredients

  • Referral criteria needs to be designed to target people for the social prescribing scheme.

  • Appropriate tools to do it properly.

  • Funding commitment.

  • Collaborative working between sectors.

  • Buy-in of all referring healthcare professionals.

  • Communication between sectors.

  • Skilled link workers.

Link workers

Link workers may be located within a GP practice or within third sector organisations. The location of where the link worker is based is not always indicative of how their position is funded or who employs them.

Technology

The opportunity to link digital inclusion agendas to both social prescribing activity and widening participation work is significant. The common thread is digital literacy. A digitally empowered patient or member of the public can do more to manage self-health. However, in patients where they have no knowledge, ability or interest, there still needs to be alternative routes. Patients familiar with social prescribing advocate that apps and technology are simplified to make them more user-friendly.

What next?

Increased use of social prescribing means sufficient resources need to be deployed. This is not solely financial but also engaging with community groups, appropriate schemes and classes, and having an up-to-date database.

To optimise the contribution of social prescribing to sustained health and wellbeing outcomes, there needs to be greater recognition among commissioners, health professionals and social prescribing services.

Social prescribing can provide a mechanism for people to get well and stay well, creating the opportunity for lasting behaviour change because it involves autonomy, is adaptable to meet needs of patients and can connect into local resource provision. Ultimately, it must be properly co-ordinated and integrated into holistic service provision to succeed.