Social Prescribing in Merton

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Overview

Merton CCG and Public health Merton have finished piloting  Social Prescribing for a  period of one year in two practices in East Merton which was due to end in December 2017. To date the Pilot generated good referral numbers (numbering greater than 200 split between the two practices) and patient behaviour has shown early promise of increased self-management and reduced GP appointments. This project has rolled over until April 2018. 

The Pilot Project is being evaluated by Healthy Dialogues and a completed report is due May 2018.

Merton Evaluation by Healthy Dialogue

The Patient Story

Existing Service Model 

The existing service model involves employing a ‘link worker’ known as a Social Prescribing Navigator working at each respective practice two days a week. The link worker is visible to the primary care team, and encouraged to be seen as a fully integrated member of the practice team. The post holder has been given appropriate training on EMIS, and has a wealth of local knowledge about services available in the community, as well as strong links to community and volunteer organisations. The post holder is an employee of Merton Voluntary Service Council (MVSC) and is supported by this organisation. The Pilot is overseen through regular meetings by a Steering Group made up of members of CCG Primary Care Commissioning team; local GPs and Clinical leads; MVSC with the Social Prescribing Navigator, and representatives from LMB Public Health team.

The referral is made when a GP refers a patient to the service and the Social Prescribing Navigator books a one-hour initial consultation. At this consultation the navigator offers strategies to self-manage the patient’s problems by either:

1)     Sign posting – directing patients to non-clinical services / self-directed advice;

2)     1:1 Assessment service where needs are complex.

3)     Assisting with form filling, benefits eligibility checks, and initial engagement in counselling. 

Some other interventions include:

1)     Improving stability of home and family life;

2)     Promoting better mental health and resilience; 

3)     Relationship guidance;

4)     Volunteering;

5)     Social connectedness to reduce isolation.

The patient is offered a follow-up appointment and the navigator records notes directly into the patient record.

Successful rollover  

The CCG have funded a further 12 months of Social Prescribing in East merton which allows all practices in East Merton to adopt this model.  East Merton houses the most deprived wards in the borough and so Social Prescribing will help address the health inequalities  and provide an access for these patients who are in need of care. 

All nine practices are engaged and once the second navigator has been appointed then East Merton will have full coverage. 

Coverage in West Merton 

Also looking at rolling out Social Prescribing to practices in West Merton, four practices have been identified in Battersea. 

Results of pilot

Merton Social Prescribing  - An update on the evaluation. April 2018.

  • In the 12 month period (1stFeb 2017 to 31stJan 2018) 316 patients have been referred (250 from Wide Way and 66 from Tamworth House).
    • Referrals have been made for patients of all ages, with the largest proportion (17%)for those between 40 and 49 years of age.
    • More women (71%) have been referred than men (29%).
    • Over half (55%) patients referred are white, followed by black (24%) and Asian (10%). This generally reflects the ethnic make up of the local area.
  • The reasons for referral (based on information recorded by social prescribing delivery staff) are mild/moderate mental health issues (183), long term conditions (151) and social needs (119), severe mental health illness (3) and dyslexia (1).
  • Self reported health and wellbeing.
    • This is measured at intervals by the Wellbeing Star, which is a validated tool to support and measure an individual’s progress to live as well as they can. Ithas eight outcomes areas; lifestyle, looking after yourself, managing symptoms, work & volunteering, money, where you live, family & friends and feeling positive.
    • Seventy five patients completed two ‘stars’ and 12 patients completed three ‘stars’ within he timeframe of the evaluation.
    • The average score of the Wellbeing star increased from 2.8 to 3.5. This is a statistically significant increase (t(86)=1.99; p= 0.00). 
    • All eight domains (*) improved at three month follow up, with the greatest in the ‘lifestyle’ domain and the least in the ‘where you live’ domain. A statistically significant increase was found across each domain.
  • Primary Care appointments.
    • 3 Months. 138 patients attended 1,641 GP practice appointments in the three months before the SP intervention and 1,098 afterwards (a reduction of 543 overall). The average number of appointments per person dropped from 11.9 to 8. This is a statistically significant decrease (t(137)=1.98; p= 0.00).
    • 6 Months. 101 patients attended 2,013 GP practice appointments in the six months before the SP intervention and 1,790 afterwards (a reduction of 233 overall). The average number of appointments per person dropped from 20 to 18. This is not a statistically significant decrease (t(100)=1.98; p= 0.08).
  • A&E appointments.
    • 3 Months. 60 patients attended A&E 39 times in the three months before the SP intervention and 20 times afterwards (a reduction of 19 overall). The average number of appointments per patient dropped from 0.65 to 0.33. This is not a statistically significant decrease (t(59)=2.00; p= 0.11).
    • 6 Months. 43 patients attended A&E 60 times in the six months before the SP intervention and 31 times afterwards (a reduction of 29 overall). The average number of appointments per patient dropped from 1.4 to 0.7. This is a statistically significant decrease (t(59)=2.01; p= 0.04).

We are unable to confirm direct causality, for example to say that the reduction in appointments or the increase in self reported health and wellbeing are due to the SP programme.  However, these findings are positive and appear to show that the SP service may have led to a statistically significant reduction in GP appointments in the 3 months following referral to the programme, and in A&E appointments in the 6 months following referral.