Social prescribing: a part of something bigger

Social prescribing is definitely in vogue – it was listed as one of the 10 high-impact actions in the General Practice Forward View; the Royal College of General Practitioners have called for every GP practice to have access to a funded social prescriber; and the last conference we held on the topic at The King’s Fund had sold out before the speakers had even been confirmed.

At The King’s Fund annual conference in November, the Secretary of State Matt Hancock stated that he saw social prescribing as becoming indispensable for GPs, ‘just like a thermometer or a stethoscope might be seen today,’ and announced a National Academy for Social Prescribing. It’s a movement that has certainly captured people’s imagination.

And it’s easy to see why it’s a popular response to the challenges faced by general practice. General practice has traditionally been rooted in local communities and GPs are trained to work holistically, which lends itself to taking an ‘asset-based’ approach to improving patient’s lives, building on personal, social community and neighbourhood assets to improve health rather than relying just on medical interventions. Research from the Citizen’s Advice and the Royal College of General Practitioners found that GPs in England reported spending almost a fifth of their time on social issues that are not principally about health. For overstretched GPs additional, non-medical referral options to help improve patients’ wellbeing could seem like a no-brainer.

But how it’s implemented is key and a few concerns have emerged for me.

First, you can only prescribe something that actually exists. Recent work, including from The King’s Fund, suggests that deep cuts to local authority funding and sometimes unhelpful clinical commissioning group (CCG) approaches to commissioning and contracting are harming the very organisations that provide the services that might be prescribed. Many are so small that they can’t absorb uncertainty or variation in their funding, particularly where that funding isn’t enough to cover their overheads or pay their staff. Many of the areas pioneering social prescribing seem to me to be those where commissioners see their role not just to stimulate a market of providers, but to create a strong voluntary sector in their area, investing time and energy in co-producing services with the local community. If social prescribing is going to work, I think leaders of commissioning organisations (and in the future, integrated care systems) need to be serious about their role in supporting a vibrant voluntary and community sector, over and above investing in specific services. It’s not a simple task and requires time, energy, attention and commitment from the top of the organisation. Public health departments in local authorities will be a key ally in this and strengthening the links between general practice and public health which were fractured during the Health and Social Care Act 2012 changes is an important challenge.

Second, I think what sets social prescribing in general practice apart is not just providing a link mechanism but providing access to skilled individuals working in a practice who understand the local community and can build relationships with patients, helping them to the best use of all the potential assets available to them. These link workers, who often come from the voluntary and community sector rather than statutory services, are critical but will also need to be supported – as with all new roles they can’t just be ‘parachuted’ into a GP practice without induction, support and ongoing investment in team building. ‘How’ social prescribing is implemented will be as important as having it in the first place.

And a final question – in my journeys around the UK talking to GPs, I have heard that one of the reasons they need access to social prescribing is because cuts to other services that might have done that linking means the GP practice is the only accessible resource left to help people with wider problems. Should we be addressing that issue too?

Social prescribing clearly has great potential but as Rob Webster said last year at The King’s Fund: ‘Social prescribing on its own won’t solve anything. It has got to be part of a bigger system, which connects the community and the assets to the services and support. And that service and support is bigger than just social prescribing.’

I agree with him.