What is social prescribing?

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Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.

But does it work? And how does it fit in with wider health and care policy?

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What is social prescribing?

Social prescribing, sometimes referred to as community referral, is a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.

Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.

Social prescribing schemes can involve a variety of activities which are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports.

There are many different models for social prescribing, but most involve a link worker or navigator who works with people to access local sources of support. The Bromley by Bow Centre in London is one of the oldest and best-known social prescribing projects. Staff at the Centre work with patients, often over several sessions, to help them get involved in more than 30 local services ranging from swimming lessons to legal advice.

Social prescribing is designed to support people with a wide range of social, emotional or practical needs, and many schemes are focussed on improving mental health and physical well-being. Those who could benefit from social prescribing schemes include people with mild or long-term mental health problems, vulnerable groups, people who are socially isolated, and those who frequently attend either primary or secondary health care.

Does social prescribing work?

There is emerging evidence that social prescribing can lead to a range of positive health and well-being outcomes. Studies have pointed to improvements in areas such as quality of life and emotional wellbeing, mental and general wellbeing, and levels of depression and anxiety. For example, a study into a social prescribing project in Bristol found improvements in anxiety levels and in feelings about general health and quality of life. In general, social prescribing schemes appear to result in high levels of satisfaction from participants, primary care professionals and commissioners.

Social prescribing schemes may also lead to a reduction in the use of NHS services. A study of a scheme in Rotherham (a liaison service helping patients access support from more than 20 voluntary and community sector organisations), showed that for more than 8 in 10 patients referred to the scheme who were followed up three to four months later, there were reductions in NHS use in terms of accident and emergency (A&E) attendance, outpatient appointments and inpatient admissions. The Bristol study also showed reductions in general practice attendance rates for most people who had received the social prescription.

However, robust and systematic evidence on the effectiveness of social prescribing is very limited. Many studies are small scale, do not have a control group, focus on progress rather than outcomes, or relate to individual interventions rather than the social prescribing model. Much of the evidence available is qualitative, and relies on self-reported outcomes. Researchers have also highlighted the challenges of measuring the outcomes of complex interventions, or making meaningful comparisons between very different schemes.

Determining the cost, resource implications and cost effectiveness of social prescribing is particularly difficult. The Bristol study found that positive health and wellbeing outcomes came at a higher cost than routine GP care over the period of a year, but other research has highlighted the importance of looking at cost effectiveness over a longer period of time. Exploratory economic analysis of the Rotherham scheme, for example, suggested that the scheme could pay for itself over 18–24 months in terms of reduced NHS use.

Several studies highlight the importance of measuring the wider social value generated through social prescribing, for example through reducing welfare benefit claims. Again, this can be difficult to measure, and may require a longer- term approach.

How does social prescribing fit in with wider health and care policy?

Social prescribing and similar approaches have been used in the NHS for many years, with several schemes dating back to the 1990s, and some even earlier (the Bromley by Bow Centre was established in 1984). However, interest in the model has expanded in the past decade or so. More than 100 schemes are currently running in the UK, more than 25 of which are in London.

Social prescribing was highlighted in 2006 in the White Paper Our health our care our say as a mechanism for promoting health, independence and access to local services. The objectives of social prescribing also support the principles set out in subsequent NHS policy documents, including the NHS five year forward view (2014), which encourages a focus on prevention and wellbeing, patient-centred care, and better integration of services, as well as highlighting the role of the third sector in delivering services that promote wellbeing. More recently, the General practice forward view (2016) has also emphasised the role of voluntary sector organisations – including through social prescribing specifically – in efforts to reduce pressure on GP services. In addition, social prescribing contributes to a range of broader government objectives, for example in relation to employment, volunteering and learning.

Although the National Institute for Health and Care Excellence does not provide guidance on social prescribing specifically, some of its guidelines relating to mental health include initiatives that could be described as social prescribing activities. There is also an increasing amount of guidance on social prescribing available for commissioners and others in the NHS and local government, as well a new Social Prescribing Network set up to provide support and share practice on social prescribing at a local and national level. In June 2016, NHS England appointed a national clinical champion for social prescribing to advocate for schemes and share lessons from successful social prescribing projects.

Comments

Shaun Steiner-…

Position
Healthcare Assistant,
Organisation
Miss
Comment date
01 February 2018

A social prescribing group helped me when my GP couldn't/wouldn't. (They couldn't even offer me psychotherapy, as there are no NHS psychotherapists in our borough.) I had severe problems last year (have schizophrenia, depression, binge eating disorder and possible hoarding disorder, and am also autistic.) I asked my GP (once) and a primary care mental health worker (twice) to refer me for an Eating Disorders Team assessment. Neither did. It was a member of First For Wellbeing staff who told me I could self-refer (no NHS staff did), and I finally got the help I needed. She assisted me with accessing support with employment skills (want to change my job), weight management and information on finding support for the emotional and sexual abuse that I haven't been able to deal with or properly disclose for over 30 years.

David Grant

Position
Retired,
Organisation
N/A
Comment date
19 March 2018

As with the other "Cure all" therapy "CBT" (Cognitive Behavioural Therapy) No one seems able to explain "How it Works"! As a retiree with a medical background, this causes me concern. We would not be able to carryout any form of invasive treatment unless we could clearly describe: A/ The method to carryout the procedure. B/ The outcome expected.
If anyone has the courage to attempt to explain the mechanism of "Social Proscription" I would be delighted to hear from you. This also applies to CBT.

Regards

David

Brenda Lammi

Comment date
27 March 2018

Having read this and other articles, and listened to an interview on Social Prescribing, I’m absolutely baffled on how this entire movement is claiming to be ‘new’ and ‘innovative’. Occupational Therapy has been researching, advocating and prescribing meaningful activity (or occupations) for over 100 years. We know, and have researched, why it works, how it works, and the best way to prescribe it (client-centredness). These professionals should be collaborating with occupational therapy and not reinventing the wheel.

Kate

Comment date
24 April 2018

I think you are misunderstanding the term "prescription". Social prescribing refers to providing a service for GPs to refer people to if their problems are not necessarily medical related. As a former medic you will be aware that people present at the GP when their problem really is loneliness, or depression caused by financial stress. So with social prescribing, a GP will refer the patient to a link worker who puts the patient in touch with services in the voluntary that can support them through their non-medical issues, e.g. housing support, physical fitness, social clubs and organisations, legal services etc. What the research is starting to show is that demands on primary care fall when a patient's overriding issues are addressed and that medical prescribing also falls. Social prescribing is not a "treatment" like CBT, it is finding a social solution for the challenges that people face in life so they are less reliant on health professionals.

mike harvey

Position
retired pharmacist,
Organisation
pharma
Comment date
30 April 2018

Our Rotary Club in Chichester has been running a scheme to alleviate loneliness called "Bridging Generations".It brings together isolated people and Health and Social Care students at the local FE College.Meetings for converstaion take place every fortniht in term time -only cost is for some required transport. contact me to find out more Mike harvey Chichester Priory Rotary Club

Katherine Rice

Position
Retired hospital doctor, now student of Social and Therapeutic Horticulture,
Organisation
University of Coventry
Comment date
17 May 2018

I would like to understand how social prescribing is funded. When a GP 'prescribes' an intervention/activity, does funding go from the GP/CCG to the organisation providing the intervention? It seems unrealistic to expect all of the costs to be met by the voluntary sector as demand is potentially so great and many worthy projects are failing due to lack of funds. Even if projects are supported by volunteers, there are still capital and running costs to be covered. Unless funding does follow the client/patient, I think the term prescribing is misleading because a normal prescription for medication/physiotherapy etc would incur some sort of cost to the commissioner. And if funding does follow the patient, how much is it and is there a limit? I would love some clarity on this.

Ross97

Position
OT Student,
Organisation
N/A
Comment date
26 May 2018

Hi David,

Although not an expert, I am an Occupational Therapy Student. Unfortunately, social prescribing is not new and has been researched thoroughly and carried out by Occupational Therapists for 100s of years. Occupational Therapist's understand the importance of Occupation's and meaningful activities; one of the ways we use occupations to improve in health and independence is through the use of social groups such as knitting (or literally anything that is meaningful to the person Gym, walking, having a meal with friends, computer games). Social Prescribing Is not a new concept but has just been re-named as social prescribing, if you truly want to understand social prescribing and how it works read occupational therapy literature! I do agree with you that GPs should be able to explain how and why it works and therefore Just as Brenda Lammi said, the NHS and those offering Social Prescribing should be working with Occupational Therapists who do this day in and day out, know the importance of occupations to a persons physical and mental well-being and will be able to explain how it works and the importance of being able to carry out your occupations as well as a whole 100 years worth of evidence and case studies to back us up.

Roderic Morgan

Position
Service User Consultant,
Organisation
Touchstone
Comment date
05 June 2018

I think that Social Prescribing works very well in Leeds. It allows service users to get access to things which can help them in their recovery. The referral process is easy and efficient.

Michael Lingard

Position
Orthopath,
Organisation
TotalHealthMatters!
Comment date
31 July 2018

70 years ago at the inception of the NHS , a group from what was called The Peckham Experiment approached the government to propose establishing Health Promoting centers throughout the country based on the twenty years experience in Peckham. The doctors who organized the experiment were investigating the origins of health. All 1000 participants in the Peckham Experiment had improved health without significant medical aid. The conclusion was that health was founded on “becoming whole” and the key to this was the family mother and father in a supportive community. The Family Clubhouse of the Peckham Experiment provided such a rich environment. This was really the early pilot study of “Social prescribing “ but the difference was that the doctor didn’t prescribe, it was the families who chose this “prescription”. The parcipants were encouraged to take responsibility for their own lives and their own health, totally the opposite to what 70 years of the NHS has created, a society that sees their doctor as being responsible for their health.

Pearl Baker

Position
Carer/Independent Mental Health Advocate and Adviser,
Organisation
Tydehams
Comment date
03 August 2018

Social Prescribing is a 'WORD' but actually means receiving the SUPPORT and HELP you are 'assessed' as needing to help 'cope' with your disability, and improve your 'being' and 'inclusion' into 'society.

If you suffer from Schizophrenia, it is NOT that easy to refer anywhere. It takes years, months of 'therapy' based on your illness, disability to even start the process of 'inclusion' based on Confidence.

I started a 'Walking' Group for three Adults, who suffer from a long term Mental Illness we have lunch then walk, one has been provided with a 'fit-bit' to encourage 10.000 steps a day. it is a slow process, but when you have been left isolated in your accommodation for years rehabilitation is a slow process.

Steven walker

Position
Community Interest Care Farm,
Organisation
Green Saplings CIC
Comment date
28 October 2018

Hello we are taking on people from Worcestershire who have been recommended social prescribing at our care farm in Great Witley. We have 110 acres of farmland wnd woodlands and we have a polytunnel and market garden and various animals with use to teach with on the farm.

Sheena Wight

Position
Occupational therapy manager,
Organisation
NHS Lothian, Midlothian H&SC Partership
Comment date
20 November 2018

As an occupational therapist I totally agree with this comment.
And would like to add - the landscape has changed significantly and I think third and voluntary sector have a massive role to play in this area of really important work. I believe occupational therapy staff should be used for teaching and consultancy work with third sector and also provide a direct fast tracked referral for those individual clients who require occupational therapy assessments is those who have the most complex, enduring and multiple long-term conditions. The need for occupational therapists to be based in Primaty Crae has never been so urgent and important!

Richard Mole

Position
Project Manager,
Organisation
Birmingham Centre for Arts Therapies
Comment date
22 November 2018

No this is not a 'new' concept. We have worked hard over the last 25 years implementing arts therapies and arts in health intervention without any statutory financial backing/support. Because we are a small charity we can not be heard. It certainly can be left to the knowledgeable and experienced CVS to pick up this work, but not without being properly supported financially. Like everything I fear that if funding is ever made accessible it will head straight to the 'big boy charities' without anything trickling down to us grassroots organisations that have been delivering community activities for years. If this is about partnership delivery then it MUST be in partnership - and these 'go to charities' can not work in silos and with usual suspects. This is my experience anyway! Buy in has to come from the medical sector too and should form part of their initial training. It is a fantastic concept.

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