It is scarcely believable that, only 20 months ago, primary care networks had not yet seen the light of day. So much water has passed under the bridge since then – and yet – so much has been achieved in the transformation of primary care, despite the system and the country having to cope with a pandemic for nine of those months
The NHS Long Term Plan, published in March 2019 was truly transformational, introducing and embedding in the system the concepts of the primary care network (PCN), personalised care and the role of the social prescribing link worker (SPLW). All three concepts are now well-established and, in the last year, the vast majority of PCNs have taken advantage of the additional roles reimbursement scheme to recruit their first social prescribers.
The introduction of the SPLW to help patients address their underlying health and wellbeing issues was not a new concept – it has been common in the voluntary sector – under various guises and job titles – for many years, but its formalisation in the Long Term Plan has made NHS-wide adoption pretty much universal.
There were, of course, not 1,000 social prescribers sitting around waiting to be recruited, so posts were filled from other caring professions; some of these appointees had experience of similar roles in the voluntary sector, whilst others just shared a passion for wanting to help people.
Nor were GPs 100% supportive. Some were sceptical about the need for the role in the first place, while others simply didn’t have enough time to consider how they might employ their social prescriber, and left recruitment and deployment decisions to the clinical director.
Over the last year-and-a-half, however, and particularly during the lockdown period, social prescribers have more than proved their worth. Scepticism has largely ebbed away as the versatility and flexibility of the SPLW became clear, and social prescribers took it upon themselves to carve out a niche for themselves as essential and valuable assets in the PCN’s multi-disciplinary team.
In February 2019 the success of PCNs, and social prescribers, was recognised and endorsed when the update to the PCN directed enhanced service provided 100% funding to PCNs for the recruitment of an additional eleven allied health professional roles. Two of these, the health and wellbeing coach, and the care co-ordinator have been specifically added to bolster the size and capability of the PCN’s social prescribing team.
The way in which PCNs have employed these additional roles has varied according to the needs and circumstances of each PCN. Some care co-ordinators are working with care home residents as part of the new PCN enhanced health in care homes requirement, whilst health coaches – in addition to maintaining a link worker caseload – are working additionally with those patients with multiple and complex issues; these patients can often benefit from a health coaching approach to help them take greater control over their own health and wellbeing.
What is increasingly clear is that, with the additional roles available, the default model of allocating a social prescriber’s time evenly across the number of practices in a PCN is no longer logical or efficient if, indeed, it ever was. The emergence of social prescribing hubs – often introduced in response to COVID constraints on face-to-face consultations – have proved highly effective.
Patient referrals are taken from across the PCN’s member practices, triaged for priority and then allocated to the most appropriate member of the social prescribing team. The hub model allows for many more patient consultations to take place, allocating the right link worker for the patient’s needs, and with the minimum of delay and double-handling.
Nick Sharples is a PCC associate and highly experienced social prescribing lead. He facilitates PCC’s SocialPrescriberPlus programme and is passionate about the many benefits that social prescribing can bring to patients and the wider community. Nick also runs training programmes in care navigation and active signposting, digital group consultations and health coaching for social prescribing team members.