The first question to consider is why would we want to introduce social prescribing into local health care systems in the first place? On the face of it there appears to be a simple answer - of course we should mainstream social prescribing (or non-medical referrals by General Practitioners that support health and well-being). It provides patients with a more holistic offer by combining traditional health care services with services that can help people with a wide range of social issues. The evidence tells us if these are not tackled they can contribute to poor health and wellbeing. There is a compelling case for primary care to invest in social prescribing as around 20% of patients see their GP for a social rather than medical problem. NHS England has published their ten high impact change recommendations; one of which is social prescribing.
So why has the development of social prescribing been so challenging?
Social prescribing is simple in theory but complex in practice, requiring health and wellbeing systems to have effective partnerships and distributed leaders who are able to champion social prescribing.
The local social network that underpins effective social prescribing requires an entirely different way of thinking about and acting within the health and care system. High impact social prescribing thrives in an environment where community health and wellbeing is central to the purpose of the local system and behavioural and financial incentives are designed with this purpose in mind.
Primary care is a critical partner in developing and implementing social prescribing but as we know primary care is increasingly coming under pressure with the number of patients requiring help and the complexity of their consultations. Social prescribing could be an answer to reducing the demands on primary care but to enable practices to do this and avoid the potential for increasing demand on primary care which may be seen as the single point of contact in a community for all needs, commissioning arrangements will need to align to new models of integrated care and focus on population health.
Many local health care systems have found it difficult to sufficiently align social prescribing plans and projects to healthcare policy and strategy. This has resulted in many projects receiving short term funding. Another challenge is the need to communicate with and gain support from a wide range of partners including GPs, local authorities and voluntary organisations.
There is emerging evidence that social prescribing works, however the lack of good quality research and variation of methods of evaluation has been a major barrier to commissioning social prescribing for local health care systems at scale and pace. The good news is that we now have a social prescribing network jointly led by the University of Westminster and the College of Medicine. This network is supporting the development of social prescribing by undertaking research and sharing good practice. The Social Prescribing Network estimates there to be over 400 different social prescribing projects nationally.
The opportunities and conditions that enable progress right now
If integrated care systems aim to improve population health by tacking health inequalities and the social determinants of health, social prescribing has to be a priority for new investment. The case for social prescribing is now greater than ever with an ageing population and more people living with long term conditions that require people to have the self-confidence to self-care and make necessary lifestyle changes. Social prescribing has the potential to provide patients with the connections, support and advice they require to get well and stay well. It also acts as a catalyst in developing community wellbeing and resilience by connecting primary care to the wider community. To enable social prescribing to thrive we need new and innovative incentives including funding arrangements such as social impact bonds. You will note the use of the word “potential” multiple times here. We urgently need more systematic and rigorous evaluation of social prescribing projects and sharing of the emerging process and outcome lessons. The Social Prescribing Network is working to support this.
In context of the core purpose of better community health and well-being, the NHS needs to start really understanding and using the language of social capital, seeing communities as dynamic networks that include voluntary and public sector services. In order to deliver on the ambition of better population health, citizen engagement from design through to evaluation of social prescribing is an essential consideration where increased attention is needed to ensure social prescribing is co-produced with communities. This will enable communities to understand what social prescribing is and how it can help them to take charge of their health.
Malcolm Bray, Regional lead for South East Social Prescribing Network
Niamh Lennox-Chhugani, Healthcare Lead, Optimity Advisors EMEA