In response to our ever more complex health needs, the NHS is moving towards more integrated, holistic forms of healthcare. General practice will be at the core of the mission and, alongside them, social prescribing link workers. Are practice managers ready?
It is no secret that modern medical conditions are getting more complex. Many people now live with multiple, coinciding long term conditions; mental health problems have been on the rise for a while now, and we are living in a loneliness epidemic. Our mental health issues feed into, or even cause, our physical ones and vice versa. Our intricate, complicated health problems call for more integrated, holistic forms of healthcare.
The NHS has recognised this. Healthcare models are being shifted towards ‘personalised care’ – giving people more choice and control over the treatments they receive for both physical and mental health problems. According to the NHS personalised care recognises that everyone is unique, and that healthcare should be based on ‘what matters’ to people and their ‘individual strengths and needs’. The personalised care model is a key component of the NHS Long Term Plan.
By 2024 personalised care will benefit up to 2.5 million people. For this target to be met, greater integration between general practice and external social services is paramount and this is where social prescribing comes in.
What is social prescribing?
Social prescribing is a way for local agencies to refer people to a link worker who can spend time with patients, identifying what wider services may most benefit them. They connect people to community groups and statutory services for practical and emotional support. Link workers also help existing community groups to be accessible and sustainable, as well as supporting people to set up new groups.
For too long, patients have been unaware of potential sources of support within their local communities, and GPs have felt inadequate when addressing patients with complex health needs within a short, ten-minute appointment window. With the introduction of social prescribing, and link workers, a robust bridge is being built between patients and the holistic care they need.
By 2020/21, there will be 1,000 new social prescribing link workers and at least 900,000 people will be referred to social prescribing by 2023/24. Since July 1st 2019, primary care netwoks (PCNS) have been able to recruit a link worker – a vital component of an extended primary care workforce – as a further push to integrate personalised care into the fabric of the NHS.
General practice has therefore been positioned as the natural home of social prescribing and link workers. Patients often turn to their GPs when they have run into social or economic difficulties; GPs encounter the lonely just as much as the physically sick. Therefore, as the heart of primary care, and the first port-of-call for matters of body and mind, it is vital that general practice and link workers develop a symbiotic relationship.
Social prescribing schemes are, typically, targeted at patients who visit their GPs but do not necessarily require immediate clinical treatment; sometimes their needs go beyond the scope of primary or secondary care for a specific condition. Link workers can signpost patients to community groups and voluntary organisations which run a wide range of activities from benefits advice and cooking and singing classes, to sports, gardening, conservation opportunities and housing help. Patients are offered methods of living well that go beyond pills and potions; they are offered methods to enrich, not just their health, but their lives overall.
This is a win-win development. An evidence review from the University of Westminster found that studies report an average drop of 28% in demand on GP services following a referral to a social prescribing service. According to the RCGP, 59% of family doctors think that social prescribing can help reduce their workloads.
The link worker ball is rolling, but more needs to be done. As PCNs become more developed, your practice will become increasingly ‘linked’ to link workers. You might even consider hiring a link worker to operate directly from your practice.
What can you do as practice manager to smooth and pave the way for social prescribing in general practice?
- Encourage and help link workers to learn about social services and community/ volunteering groups in the local area. Help them grow contacts and form relationships.
- Provide link workers with information about your practice’s unique demographic. You may have a higher than average amount of patients with diabetes, or who are overweight, or who have young families. Your practice will fall somewhere on the deprivation scale. These statistics can help your link worker source the services your community really needs and could provide the necessary seeds for your link worker to set up a new group that tackles a specific problem.
- With more hands-on-deck and more ‘bridges’ between different types of health and social care, there will, inevitably, be more paper-work and greater chance of confusion or disorganisation. To avoid a ‘too many cooks spoil the broth’ scenario, help integrate link workers into your practice environment. Invite them to practice meetings so they can get to know the GPs and other practice staff. Better integration breeds better communication, leading to the seamless delivery of services.
- Make the importance of link workers clear to your practice employees so that they collaborate with them properly and whole-heartedly from the beginning. Change can be met with scepticism – so ensure colleagues are open to new, holistic models of working. Direct employees to the evidence; social prescribing works and will reduce the pressure on them in general practice.
If a patient visits the GP expecting to be dealt with only by them, or by the local hospital, it may be disorientating to find themselves referred to other, previously unheard-of professionals or services. Make sure your patients are aware that they may be referred to a PCN or practice link worker. Create a leaflet or poster on social prescribing to display in your practice. Spread positive messaging around social prescribing on your website and social media platforms so that patients don’t think they are being ‘fobbed off’ by their doctors. Once patients are familiar with the social prescribing model and what it can offer them, it is sure to be embraced.
Social prescribing and personalised care are the future of NHS primary care. For more information and to keep up-to-date, visit the NHS website.