On 21st March I attended Westminster Health Forum Keynote Seminar: Where next for Social Prescribing in England - outcomes, patient choice and cost-effectiveness. This is the second in a series of planned posts on the development of the Social Prescribing care model. Our objectives are: to amplify ideas and support debate.
Since the inception of the NHS in 1948, people are living longer and, as a result, are developing more complex, long-term conditions. In addition to this, the care needs of the UK population are changing. According to Dr James Kingsland, "we know that at least 40% of people presenting to a GP, or within a general practice, have psychological aspects of their care need".
It is now accepted that the need for the reform of the current structure of the NHS is urgent, for a service capable of meeting the changing needs of the population.
The Social Prescribing model is a prevention-focussed initiative with personalised care at its core. Dr Michael Dixon, National Clinical Champion for Social Prescribing, NHS England and Co-Chair of the Social Prescribing Network describes it as "a community that has the infrastructure to create health".
Over the last two years, a grass-roots movement of frontline practitioners (in partnership with the NHS) have been working to incorporate the Social Prescribing model alongside the Medical model for the purpose of testing and evaluating the benefits.
Social Prescribing aims to support 20% of patients with mainly social problems, high users of hospital and GP services and people with high health risks.
In future, it is envisaged that communities (referred to as 'Neighbourhoods', with approx. 30,000 - 50,000 population) will structure support on a local level, based on the services available and the needs of the area. The target size of these Neighbourhoods is deemed to be beneficial; whilst they are small enough for personal relationships to be embedded, they are big enough for economy of scale.
Key to the success of the Social Prescribing model are Link Workers. A link worker is trained to assist patients with implementing the support requirement recommended by a Prescriber from a Menu of Activities. The treatment of a patient, referred to as 'Patient Activation' is currently measured in four Levels, ranging from Level 1 'Disengaged and Overwhelmed' to Level 4 'Maintaining behaviours and pushing further'.
The activities included in the Activates Menu are intended to be provided by a range of voluntary organisations tasked with providing a variety of specialist services, including Exercise, Arts Interventions, Benefits Advice and Volunteering Opportunities.
Currently, there is no formal training programme in place for Link Workers. Dr Michael Dixon stressed that is essential to make this role fit for purpose. He stated that they are currently looking at the development of an academy to provide training and to “fulfil the demand that’s rapidly occurring at the moment”.
Within the current Social Prescribing model, Neighbourhoods have been determining the structure of this role based on their requirements. A repercussion of this, as highlighted by Dr Julie George, Public Health Consultant, Surrey County Council, is that it has led to "conflicting expectations of what a link worker might be able to do".
At present, 12 CCG's have adopted Social Prescribing (e.g. Surrey, Rotherham, Tower Hamlets and Gloucestershire) and 50% of CCG's have some Social Prescribing provision within their area.
The requirement to evidence the benefits of the Social Prescribing model to CCG's has proved challenging, but this situation is changing, with both Rotherham and Gloucestershire reporting a 20% reduction in GP consultations and hospital attendances.
To ensure the success of the Social Prescription model, there is a requirement for a common evaluation framework so that an effective comparison can be made with the existing model and cost-effectiveness can be determined. With this in place, it is more likely that sustained funding can be sourced to secure its future.
As highlighted by Rt Hon the Lord Howarth of Newport, Co-Chair, All-Party Parliamentary Group on Arts, Health and Wellbeing, evaluation is key to demonstrate to policymakers and funders that Social Prescribing is “the real deal, that it can work”.