With the introduction of primary care networks, and the inclusion of social prescribing link workers in these new primary care network teams, GP Dr Marie Anne Essam sees new opportunities opening up for people and practices
This is an edited version of an article first published by the NHS
A safe, warm, pleasant home.
Enough money to feed the household.
People who care and would support me if I needed it.
A sense of belonging and a purpose to my days.
Opportunity to exercise and enjoy fresh air.
Peace of mind.
These are just a few of the things which social prescribing has made me realise are missing in some people’s lives – especially those patients for whom my ‘medical’ expertise has not provided the whole answer.
This is such a thrilling time to be a GP. We’ve been handed the key to new doors – a simple and effective way to address the wider ‘psychosocial’ determinants of health, and see people make progress which none of us imagined possible.
The advent of primary care networks (PCNs) is our opportunity in general practice to connect ourselves – via our link workers and their nearby colleagues – to the communities in which our patients and their families live.
The isolated hoarder whose drains were unblocked, who found community, family and the joy of giving, who taught me how essential being wanted is for wellness, and how the ‘medical’ bits of care fit in so much more usefully once the really important issues are addressed.
The physically fit, but workless, bitter, man for whom everything I’d tried as his doctor had failed, including psychiatry and psychology. He is now confidently working in a garden centre, restoring old furniture, as a result of careful mentoring which helped him find the courage to participate in the Building Better Opportunities Scheme.
The ‘high intensity user’ of A&E whose repeated attendances for ‘non-cardiac chest pain’ boiled down to a series of interlinked anxieties, fears and longings. Gentle reassurance that each of these mattered, and could be addressed in some way, has resulted in better mobility in and out of the home, and his hospital visits have already reduced.
The magic of the link worker
The ‘link worker’ is my colleague, who takes the time to build bridges. By building trust, and taking a ‘What matters to you’ approach, rather than the ‘What is the matter with you’ route we tend to practise in busy primary care, a unique action plan emerges. Through active listening, mentoring, and coaching, the link worker is able to spark the previously missing motivation.
These are people who would add an information leaflet to a pile of, already discarded, dreams, but who respond to the relational approach of the link worker. The link worker works with them, often seeing them first at home and then, typically, making between six and 12 contacts with them until they are, for instance, clearly connected with a community group, or have a more secure and happy home circumstance. They might also have the support they need as a career, or are on a new pathway to work, whether paid or voluntary.
Link workers do not need to work in isolation, and are best seated in a local fraternity of other like-minded, problem-busting colleagues – colleagues who will bravely advocate for people in the realms of housing, finance, family, probation, addiction and community support, to name but a few.
Of course, a lot still needs to happen in our communities to ensure the necessary resources are there. Investment in the voluntary sector, in community agencies, and in organisations providing grants, advice and access to education, work experience and so forth, is mission-critical – but our link workers in PCNs give us the opportunity to connect ourselves to the communities in which our patients and their families live.
Collaboration and understanding will grow between primary care, local organisations and local authorities. This, in turn, will contribute to a changing landscape as commissioners and providers rearrange themselves into integrated care systems. I believe what we will see, on the large scale, is the marvellous art of the possible – which we are already seeing on an individual level – as social prescribing delivers personalised, holistic and empowering care.
In the Long Term Plan NHS England committed to building the infrastructure for social prescribing in primary care. They promised to put 1,000 new social prescribing link workers in place by 2020/21, with significantly more after that, so that at least 900,000 people will be referred to social prescribing by 2023/24.
This is part of the drive towards universal personalised care.
Information about the learning support offer for the new PCN link workers can be found on the social prescribing web page.