Social Prescribing

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Social prescription facilitates patients with a range of social, psychological and physical problems to access a wide range of local interventions and services provided by the voluntary and volunteer sectors and others.[1]

Definition of social prescribing

A means of enabling GPs and other frontline healthcare professionals to refer patients to a link worker - to provide them with a face to face conversation during which they can learn about the possibilities and design their own personalised solutions, i.e. ‘co-produce’ their ‘social prescription’- so that people with social, emotional or practical needs are empowered to find solutions which will improve their health and wellbeing, often using services provided by the voluntary and community sector. (National Social Prescribing Network)

What is Social Prescribing?

Social prescribing sometimes referred to as community referral, is a means 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 – King's Fund [1]

According to the UK's "National Social Prescribing Network" Social prescribing "enables healthcare professionals to refer patients to a link worker, to co-design a non-clinical social prescription to improve their health and well-being" [2]

Traditionally healthcare has been provided by health professionals, such as doctors, nurses, and occupational therapists based in a range of NHS settings including primary care. People’s health and their ability to manage it are influenced by a wide range of factors beyond the scope of these professionals’ practice. Such factors include employment, housing, debt, social networks and culture which have been estimated to account for 57% to 85% of the determinants of health status [2].

For those with long-term conditions, these social determinants make a significant contribution to health and wellbeing as well as impacting on recovery and independence. Help with these factors is frequently available in communities, including local authority and community based organisations outside of the NHS (Buck D. & Gregory S. 2013, and Parsfield M. et al (eds) 2015) [3][4]. These organisations could provide opportunities for people to access information, advice and guidance, and they could also contribute to building their skills, knowledge and capacity.

Social Prescribing acknowledges this range of factors which impact on health and wellbeing and the management of long-term conditions but may not be amenable to more traditional health interventions. It is a means whereby health professionals and others can signpost people to resources which can help with these aspects of their lives. It reflects the “social model of health”, which takes a broader view than the traditional medical model and recognises the part a wider range of partners, including individuals, carers and families, can play. Although the term ‘prescribing’ fits with a medical model, in this case, the prescriptions are for non-medical interventions - for participation rather than pills. Medication which has been prescribed but not used has been estimated to cost the NHS in England £300m per year (York Health Economics Consortium/School of Pharmacy 2010)[5].

The Social Prescribing Interface

Social prescribing might be seen as the place where the NHS “meet” the community and its assets, as illustrated in figure one below. It builds on the experiences of implementing personalisation and models of care advocated by disabled people over many years, promoting person-centred collaborative care [6]. It works best when NHS and local authority commissioners, GP and primary care teams, voluntary and community sectors all work together.

This makes social prescribing a good vehicle for improving integration of NHS, Local Authority and wider community resources, improving efficiency and making these resources known and more accessible to people who could benefit from them. It also puts the patient back at the heart of their own network, making connections between the range of relationships, activities and services that support their wellbeing.

Social prescribing can stimulate creativity and innovation and enable access to a whole range of interventions, and activities, often developing locally through small groups connected to local communities and meeting local needs.

Some of the core elements of existing social prescribing schemes are:

  • Partnership between the NHS and diverse voluntary sector, social enterprise, and community organisations;
  • Holistic assessment which takes account of the range of factors influencing health and wellbeing and reflects each individual’s priorities and goals
  • Coordinated and personalised support plans, with information, advice and guidance aiming to support and motivate people, and build links to community assets and resources
  • A focus on broader aims than traditional healthcare may be able to offer - including the well-being, effective functioning, and social connectedness of people and their families.

Many local social prescribing schemes provide access to support for healthier behaviours, such as exercise, healthy eating and improving mental wellbeing. Several schemes support networks and interaction, opportunities to access the benefits of the environment and green spaces, adult learning, the arts and culture.

The specific content of schemes varies, but typically may include:

  • Provision of information and advice
  • Opportunities for arts and creativity
  • Physical activity
  • Learning and volunteering
  • Peer support
  • Befriending and self-help
  • Support with benefits, housing, debt, employment, legal advice or parenting

Social prescribing commissioning

Main article on Social prescribing commissioning

With the current financial challenges facing public services, the arguments for social prescribing are strengthened and more likely to be approved by CCG boards if the business case highlights the potential savings and benefits to the NHS as a result of the investment. This will include moving activity upstream, with people learning to care for their health better and so requiring less formal and/or emergency healthcare. Also, the experience of social prescribing schemes is that they often generate a workforce of peer supporters who have benefited and want to contribute more themselves (e.g. in City and Hackney[1]). 

Social Prescribing in London

London Voluntary Services Council produces and regularly updates a social prescribing map for London which is available at http://www.lvsc.org.uk/programmes/health/social-prescribing-in-london.aspx

There are at least 61 different social prescribing schemes operating across 27 London Boroughs. There may be more schemes in areas we have not yet come into contact with.

Social Prescribing Schemes in London

How to implement social prescribing?

Main article on Steps towards implementation

Contracting, governance and risk

Main article on Contracting, governance and risk in social prescribing

Monitoring and evaluating social prescribing

Main article on Monitoring and evaluating social prescribing

A recent independent evaluation showed significant qualitative benefits [3] in line with other studies that are indicative of cost-saving potential.[4]

Social prescribing for children, young people, parents and carers

Main article on Social prescribing for children, young people, parents and carers

This section is intended to help develop social prescribing for children, young people, parents and carers

Examples

In the London borough of Hackney a social-prescribing scheme is in place, in part due to a vibrant voluntary sector in Hackney and lots of very proactive G.P.s. Clinical Commissioning Groups (CCGs) tend to follow clinicians lead, and so initiatives coming from doctors can make all the difference. Hackney CCG ran a tendering process for setting up social prescribing and got a service provider to implement it for them. Healthy London Partnership has produced a report intended to help CCG commissioners make decisions about implementing social prescribing [5]

Relation to other Approaches

The relationship between people, person-centred approaches and appropriate support

Social prescribing can stimulate creativity and innovation and enable access to a whole range of interventions, and activities, often developing locally through small groups connected to local communities and meeting local needs.

Enabling approaches

In this section we describe the importance of investing in patient activation, workforce development, and digital engagement. These approaches and the advice in that resource are directly relevant to developing successful social prescribing schemes.


See Also

Self Care


Related Wikipedia Articles

References