Zoe Williams: The future for general practice using social prescribing

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  • Posted:Tuesday 20 November 2018

Dr Zoe Williams, GP and Clinical Champion for the Royal College of General Practitioners’ clinical priority ‘Physical activity and lifestyle’ speaks at the closing plenary of our event in November 2018, Social prescribing: coming of age.

Transcript

When I first became a fully qualified GP in 2013, my first practice that I worked in as a fully fledged GP gave me a few patients who, you know were sort of what we call frequent flyers so that I could have my regular patients and one of those patients was Barbara. Barbara was 74 and she had high blood pressure which was pretty well controlled on medication. She had osteoporosis. She was classified as at risk of dementia. She was pre-diabetic. Anyway, one day I was doing my big pile of prescriptions and I came across Barbara’s prescription. She hadn’t been in for six months to get her drugs and I thought, oh my goodness, what’s happened to Barbara? So I panicked and thought where’s Barbara? So it got me to reflect a little bit more and beyond her problems list that we see when we first look at a patient’s record, the things that should have featured there that didn’t along with those things that you see was that she was widowed, that she was lonely and that she was afraid. She was terrified that she was going to get type II diabetes or that she was going to get dementia because her husband had it. 

It was a Thursday, so I rang Barbara and there was no answer. So it was Tuesday before I got a chance to ring her again and she didn’t pick up the phone. So I thought, where is Barbara? So I rang her daughter and her daughter told me where to find her and on Tuesday afternoon this is where Barbara was. She was at Silver Fit which is 200 metres down the road from my practice in Burgess Park. So that’s where Barbara was, she was at Silver Fit. I said, but that’s on Tuesdays Barbara, where were you on Thursday? She said Thursdays we do cheerleading. I was like, oh right okay, fair enough. 

I think that physical activity is like the glue when it comes to social prescribing. It’s the one thing that can bring it all together. It doesn’t have to be, certainly doesn’t have to be sport. It doesn’t even really have to be what we think of as physical activity. Just movement and getting out of the home. So whether that is singing for COPD. Singing in itself for someone who has COPD is a form of physical activity, whether it’s leaving the home and walking to that community venue where you’re meeting up, whether it’s getting out and about with the family. I would urge you as to whatever you’re doing within social prescribing, always think about physical activity. If you’re a link worker and you’ve booked that patient an appointment at the job centre the next day, ask them how they’re going to get there. Instead of them getting the bus, might make them feel better if they walked that 20 minutes. 

These are kind of my tips really. The what, the how and the who. So the what, so the way to talk to GPs is by telling them how social prescribing can help them and help their patients, and in particular how it can reduce workload because whenever there is a new idea, a new concept, introduced to GPs they always think this is something else for me to do and if you actually lay it out for them as actually this is something that’s going to help you do less and benefit your patients, then that’s the way to tell it to them. 

Remember GPs, we are good people but we are under staffed, under resourced, stressed and burnt out and we really want our patients to, we really want to spend more time with our patients and we really want to learn the 200, 300 different opportunities that are available in our locality for them, but realistically we’re not going to retain all that information. So, I think we definitely do need social navigators or link workers or care navigators, we definitely need those people to support us. 

The who? Who can you get support from? Clinical champions, there are loads of GPs and hospital doctors and medical students who are really engaged with this message. Targeting those people is going to really, really help you out but just sort of reaching out to all GPs, you’re probably, you know it’s not that they’re bad people, they’re probably just not going to hear it. We’re just overworked and over flooded with information. So thinking about who else in the practice can you engage with then? Practice managers, practice staff. You don’t necessarily need the GP on board a lot of the time.  Within the CCGs it’s really difficult to know who to contact but each CCG has various different GPs working within it and often one of the GPs will be the prevention leads and patients, don’t forget patients. So patients are your biggest advocates. We listen to the patients.

I went to find Barbara and she actually told me that she knew about Silver Fit because I gave her a leaflet about Silver Fit, which I’d completely forgotten about. So, you know, there you go.

And finally then, the how? So, just keep going is one of the things. Make it as easy as possible for the GPs. Remember that those people who aren’t yet engaged with social prescribing will be, they’re just a little bit far behind so don’t lose hope in them, they’ll catch up and that’s really it for me. 

So the last thing I wanted to say was, on behalf of me and the whole GP community, those of us who are engaged and those of us who aren’t quite there yet, just a massive thank you for everything that you do. You will feel disheartened at times but please keep going because our profession needs you and most importantly the patient needs you. So thank you very much.