Twelve months ago, Dr Michael Dixon set out his vision for the Social Prescribing model, a prevention-focussed initiative with personalised care at its core: https://bit.ly/2PfGLkm

This is the third in our series of planned posts on the development of the Social Prescribing care model.  I attended the Westminster Health Forum keynote seminar, Next Steps for Social Prescribing in England, 26th March 2019, to hear how Social Prescribing is moving forward with the NHS Long Term Plan. 

In March 2016, Social Prescription was launched in the House of Commons as a national movement.  Many patients are now enjoying the benefits of a variety of alternative therapies, such as art classes and exercise.  The service is currently supporting patients with mainly social problems, high users of hospital and GP services and people with high health risks.  Dr Michael Dixon, National Clinical Lead, Social Prescribing, NHS England, suggested that this group will be expanded to include, "Those with just one long term disease in order to pre-empt them from developing further long-term disabilities, children and adolescents, the homeless, and prisons."

In line with the NHS Long Term Plan, GP practices are in the process of creating local Primary Care Networks.  Dr Dixon advised that it is a priority to inform, educate and enable GPs to universally bring about this major shift in perspective, aided by NHS England regional networks and the Royal College of GP Champions. 

A certified training programme is being established for the first 1,000 Link Workers, and it is hoped that this number will rise to 4,500 by 2023.  A membership organisation for Link Workers has been created.  Dr Dixon suggested that candidates should ideally be locally based, and potentially have benefited from Social Prescription themselves.  He went on to propose developing local, regional, and national menus for Social Prescription. He noted that it should be, "Complementary to current services and not become an apologist for inadequate services." 

Chris Easton, Head of Person and Community Centred Approaches, Tameside and Glossop Integrated Care NHS Foundation Trust, stated, "We need to bridge the two system; the medical system and the social system... We need to keep a broad Social Prescribing narrative.  It's not just about Primary Care.  It has relevance right across the system.  We need not to disenfranchise other parts of the system across health and care."

In his view, Social Prescribing sits at the heart of public service reform.  He emphasised the importance of co-production, because without investment and support from the Voluntary Sector, Social Prescribing will fail.  The Voluntary Sector need to be respected as equal partners. He advised that Tameside have been working with the community to be advocates of the service, and it has been really successful. 

Bev Taylor, Senior Manager, Personalised Care, NHS England, highlighted the issue of funding.  She confirmed that the NHS cannot fund every community and voluntary organisation around the country, so building successful partnerships will be essential to sustain the system.

"It's about local ecosystems, local partnerships.  Everybody can benefit from it if we build it together."

Bev Taylor, Senior Manager, Personalised Care, NHS England

In Gloucestershire, Social Prescribing is proving to be very effective.  Ellen Rule, Director, Transformation and Service Redesign, NHS Gloucestershire Clinical Commissioning Group, reported that 40% of individuals reduced their number of GP contacts after involvement with a Social Prescribing initiative. The biggest recorded reason for patients accessing Social Prescribing is mental health and wellbeing. 

Ellen Rule advised that they have adopted a universal Social Prescribing budget, investing £850,000 per year.  Seed money is available to help and support groups to get going.  They also operate a Social Prescribing Plus model, where groups of patients with a specific issue have a Social Prescribing initiative designed around their needs. 

Gerry Taylor, Corporate Director, Public Health, Commissioning and Procurement, Luton Borough Council, reported that the Local Authority commissioned the Total Wellbeing Service jointly with Luton CCG, which encompasses lifestyle services and Social Prescribing.  Their aim is for the service to bring together physical health and mental wellbeing.  The service is currently being run by a mixture of professionals and volunteers, but they hope that in future people who have benefited from Social Prescribing will become volunteers themselves. 

Gerry Taylor suggested that the primary reasons for referral to the Total Wellbeing Service are:

• Weight management / Healthy lifestyle support - 34%
• Low mood / Emotional health difficulties - 28%
• Accessing social and community groups / Loneliness and isolation - 15%
• Long-term conditions support / Disability support - 3%
• Support with substance abuse - 1%

The ability to evidence the effectiveness of Social Prescribing initiatives will be key to sustaining investment long-term.  Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care, NICE, revealed that NICE have been looking at initiatives such as singing and exercise classes.  The difficulty with arts and evidence is that the evidence base is often very limited.  She advised that evidence is often, "Not enough; of poor quality; conflicting; or the wrong sort." 

"Without good evidence, we can't do a robust economic evaluation to compare interventions.  Therefore, healthcare systems can't see they're value for money and commission relevant services."

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care, NIC

Professor Leng emphasised that commissioning research needs greater collaboration between science and the arts, to ensure the methodology is effective.  In future, NICE will be developing and updating advice using data at all stages.  When measuring the impact of a service, quality standards come with measures to help drive improvement.  She is keen that the quality standards drive change and data collection, as both of these activities will help to demonstrate outcome and encourage further investment. 

Dr Michael Dixon reflected in his closing remarks that last year there was no sustainable project in the country.  But, whilst much work has been done, there is still a very long way to go.  He noted that, "I think that, more than anything else, what Social Prescribing offers people is hope - and, more than ever, we need that now."

Post Contributor:

Caitriona Fitzsimons Digital Reporter