Social prescribing commissioning

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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 up stream, 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]). There is a growing body of evidence demonstrating some specific benefits which may be achieved for patients and their local NHS through social prescribing including:

  • Reduced hospital admissions and A&E attendances
  • Reduced outpatient appointments
  • Reduced GP consultations
  • Improved health and wellbeing
  • Reduced social isolation
  • Increased engagement in health-related activities
  • Reduced reliance on medical prescriptions

Social prescribing can alleviate pressures on the system. GPs are very busy, and this is not just with treating health conditions. For example, 80% of GPs reported that dealing with non-health queries results in reduced time to treat health issues and 46% reported this increased costs to the practice and NHS (Citizens’ Advice, 2015)[2]. Of those who used Citizens’ Advice Bureau between January and March 2016, 46% had a long-term health problem (Citizens’ Advice 2016)[3]. A business case for social prescribing could be based on the objective of containing expenditure at current levels rather than necessarily reducing it.

Three UK service evaluations include outcomes and impacts for the NHS such as:

  • 60% reduction in GP contact times in the 12 months following intervention compared to the previous 12 months (Bristol Wellspring Project; Kimberlee R. 2016)[4].
  • 25% reduction in A&E attendance in the social prescribing group, with a 66% increase in A&E attendance by the control group. (City and Hackney Clinical Commissioning Group & University of East London 2014)[5].
  • 17% reduction in A&E attendance and 7% reduction in non-elective in patient stays were reported in the 12 months post intervention compared to the 12 months before it from the most recent evaluation report from the Rotherham Social Prescribing Service (Dayson C. & Bennett E. 2016)[6].

Where Social Return on Investment (SROI) is reported, this is usually greater than to the NHS alone. The Bristol Wellspring project for example estimates a social return of £2.90 in year for each £1.00 invested. More information on Social Return on Investment (Cabinet Office 2009) can be found at the Social Value UK [7] site.

Financial Modelling

The Healthy London Partnership commissioned i5Health [8] to model the potential financial benefits for London’s NHS of increased use of social prescribing. Their model suggests that London potentially would have saved £110m between 2013-16 if it had made greater use of social prescribing. They used pseudonymised21 patient data to estimate potential NHS returns on investment based on evidence from social prescribing for London’s CCGs. Each CCG has now received a copy of this modelling. They used the Hospital Episode Statistics for the last 3 years from this patient cohort to model potential historical savings and potential future savings (to 2020-21) of specific social interventions. They did not include intervention costs in the calculation as they can vary significantly. For example, some provision relies on volunteer workforce, others paid workers, some will fund offices, others will rely on existing and free space etc.

For example, in 2015-6, spend by the NHS in London on activity in secondary acute care for 4,794 people with mild to moderate MH conditions was £5,714,725. 1,892 of them may have benefited from a community arts scheme. If they had been referred and benefitted from the scheme in accordance with the cited evidence, the NHS in London potentially would have saved £1,416,606 through reduced secondary care activity in that year.

When modelled forward, this leads to a potential average saving of £1,403,770 per year for London for this group benefitting from arts on prescription.

It is important to note that modelling for potential savings by initiative results in large variations due to differing impacts on secondary care health service usage.

Impact & Implementation matrix for social prescribing programmes in London

This orthogonal model is designed to give an easily accessible indication of where commissioners can invest in relation to financial impact. It does not indicate the value of initiatives beyond financial return to the NHS. For example, education on prescription is in the harder to implement and low impact box, but there is good evidence for the benefits of education for people’s health, life chances and quality of life [1].

As part of the Realising the Value workstream [2] NESTA have just released an economic modelling tool which is a pivot table allowing customisation to local CCGs to estimate returns on investment from approaches which were examined as part of this work (group activities, peer support, health coaching and self-management [3]).