I was privileged to take part in the inaugural conference of the new national Social Prescribing Network in London recently. I was there to champion the role of the voluntary sector in social prescribing schemes, and I was delighted to see that all the schemes represented had the sector as a key aspect, to greater or lesser degrees.
In a breakout discussion I facilitated we looked at some of the barriers to good provision:
- Referrals to unfunded provision or lack of provision due to closures of local services and organisations.
- Lack of attention to capacity/capability of frontline providers.
- Over-bureaucratic commissioning processes, that might, for example, prevent the possibility to prescribe appropriate services or activities delivered by very small, sometimes unincorporated groups.
- Lack of awareness or interest in even the concept, which would mean GPs do not refer, or a culture in a GP practice that is not conducive to social or community asset based models of health improvement.
- Lack of a commonly agreed definition of social prescribing, or agreement on the scope of a social prescribing scheme. This is one of the aspects that the emerging Social Prescribing Network is hoping to tackle.
There was also a tension between a pull towards standardisation and regulation, for the purposes of influencing policy, whilst maintaining the need for services to be designed and co-produced locally to meet local needs, which would mean the emergence of a variety of models and methods.
What makes social prescribing successful?
Some of the key critical success factors I came across during the conference:
- The presence of an ‘enabling culture’ which exists across the health system, for example commissioners being willing to co-produce solutions, GPs being willing to trust other professionals to assess and direct ‘patients’.
- Excellent information and communication channels across the whole system, for example up-to-date knowledge on the availability of specific local services or activities, client notes being recorded in the formal GP medical notes, and mechanisms to report outcomes and impact (clinical and economic) to GPs and commissioners.
- A high level of skill in the link worker/navigator/champion (and there were many versions of this job role). One navigator from Devon talked about how she works very proactively, going out into the GP waiting room and talking to people, going out and about and engaging people informally, and generally becoming the ‘go-to’ person in the community.
- Solid infrastructure support, firstly in terms of the coordination and strategic development of the service, and secondly to professionally support the staff and volunteers engaged.
What is the end-game?
It struck me more than anything that we’re still trying to crack some age-old problems.
- How to engage GPs meaningfully in solutions that will not only help their patients to take control of their health, become more independent, etc, but also reduce their caseload and save them money.
- How to ensure that services and activities properly meet the needs of local people, reach those that find it most hard to access services and make a real difference to people’s lives.
- How to convince decision makers that upstream interventions pay for themselves many times over in the longer-term.
- How to ensure there is a network of service provision that is sustainable and not bogged down by the madness of annual funding cycles. A GP practice manager from Gateshead insightfully pointed out that the very services in their area that meet the needs of the most vulnerable people are in themselves vulnerable due to short-term funding. How long have we been saying that?
Some say that this could be the fashionable concept of the moment. But if the term enables GPs to understand a bit more clearly how the wider social determinants of poor health can be addressed, and how local communities and ‘patients’ themselves are best placed to solve their problems, and if this work generates debate and creates better ways of working at a local level, then it can only be a good thing.
I’m really keen to hear from anyone engaged in or developing social prescribing schemes, so that you can take part in the network, and can also help NCVO to form policy and influence decision makers.
- Please get in touch either by responding to this blog post below, or emailing email@example.com or tweeting me @LevPedroNCVO.
- To join the network, please email firstname.lastname@example.org mentioning that you heard about the network from Lev Pedro’s post on the NCVO blog.
- Evaluation of the Rotherham pilot
- Richard Kimberley – What is Social Prescribing?
- Social prescribing seminars at the Bromley-by-Bow Centre, east London
- UCL review of social prescribing models
- Cultural commissioning projects