Beyond medicine – barriers to widespread adoption threaten social prescribing

Jonathan Finch, web content editor at First Practice Management, discusses the current social prescribing situation

It was reported back in 2016 that around 20% of patients who consult their GPs are actually asking for help with a social problem, rather than a medical issue; that one-in-five patients fall into this category indicates just how important our social situation is, and how intertwined our socio-economic circumstances are with our overall health. It was precisely this more holistic approach to the population’s healthcare at large that social prescribing was designed to promote.

However, social prescribing is still not as widely known, or recognised, as it might be and, despite the numbers of patients who could benefit from it rising every year, more and more link workers who facilitate this care are thinking of resigning.

More than ten years since it was first spoken of, what’s going on with social prescribing?

Beyond medicine

When it comes to providing care which goes beyond medical diagnosis, and touches on non-medical aspects of patients and their lives, GPs have always been uniquely placed. They operate beyond the biomedical model, unlike more specialist colleagues; together, both approaches are crucial to patient outcomes.

Social prescribing (also known as ‘community referral’) seeks to refer patients to services in the community, which are non-clinical, such as sports, group learning, or social activities. Nurses and GPs issue the lion’s share of these referrals and, importantly, these ‘social prescriptions’ can help individuals to play a more active role in taking charge of their health.

Social prescribing also plays a key part in the NHS’s plan for Universal Personalised Care. In its ‘comprehensive model’ – which, it is claimed, will benefit 2.5m people by 2024 – the NHS plan lists six key components, one of which is ‘social prescribing and community-based support’.

Barriers to widespread adoption

Despite the benefits, there are currently many barriers to widespread adoption of social prescribing; lack of time, resource and training has meant that there is a wide variation in uptake throughout the country. The role of link workers within multidisciplinary teams also varies significantly in its remit, and is not always recognised. Of course, the COVID-19 pandemic has created its own issues too, with most link workers’ time now being largely taken up with the vaccine rollout.

Some of the statistics make for grim reading. A survey conducted by the National Association of Link Workers in June 2020 found that 29% of social prescribing link workers were considering resigning due to a lack of support and/or clinical supervision and, of these, more than three-quarters were based in GP surgeries; 61% of those surveyed reported no clinical supervision at all, and one-in-ten had no support of any kind whatsoever. However, statistics also showed that 59% of GPs themselves see social prescribing as a valuable aid to reducing their unsustainable workload, one of their most pressing problems at the moment.

The cure?

The aim set out in the NHS’s Long-Term Plan is that, by 2023/24, at least 900,000 people will be referred to social prescribing – but, in order to achieve this, several things must be done:

• Raise awareness of the role of link workers, so that GPs and other staff in primary care roles know about them and the benefits of social prescribing. Bodies like the RCGP and the National Academy of Social Prescribing (NASP) are well-placed to do this (the NASP’s Chief Executive also featured in a recent podcast which tackled the issue of loneliness, an important, and often-ignored, part of community care, for which there is now a Minister for Loneliness).
• Ensure better, and more defined, communications between link workers and the primary care colleagues they work alongside.
• Recruit more link workers and increase their capacity to do more.
• Underpin policy support for social prescribing with proper funding for community organisations, especially local charities, so it can be a truly long-term and sustainable system.

Innovation and lateral thinking are key to helping the NHS, its staff and patients, meet the challenges of the coming years. Social prescribing—far more than merely signposting patients to other services—is one of these innovative tools, where patients are helped to understand the root cause of their problems, not just the ‘cure’. They are able to see what they want to achieve, and how they can make it happen themselves.

That is a valuable tool for our health service and one which must be protected.