Comment

09.12.16

Social prescription: A trojan horse for a health creating community?

Source: NHE Nov/Dec 16

Dr Michael Dixon, social prescribing lead at NHS England, discusses the opportunities and challenges facing social prescribing.

Social prescription is an idea whose time has finally come. It was virtually unspoken of a year or two ago, and is now poised to become national policy and part of the furniture of every GP consultation within the next few years.  

The idea is elegant and simple. The prescriber will meet with the person to understand their hopes, needs, challenges and obstructions. They then choose from a menu of non-biomedical interventions which range from voluntary services, to local authorities and the private sector to offer them an effective intervention. These non-biomedical interventions ultimately reduce the load on the health service. For example, patients who see their GP for social problems like benefits or housing advice, occupation experience or befriending may need social rather than medical intervention. 

Less intuitively, social prescription can vastly reduce the use of health service resources in patients with long-term conditions who use it most. It can motivate patients to care for themselves better and thus need interventional care less. 

The move towards social prescription is rapidly developing in every part of the country. From the original seeds of development in Newcastle, Burnley, Bromley by Bow and Devon there are now eight CCGs that offer universal access to social prescription for GPs and patients, and 49% offering some support. Our national network of those leading social prescription increased from 100 to 500 between January and September. 

National commitment 

Social prescription is also mentioned both in the FYFV and the GP Forward View. It has even become one of NHS England’s 10 high-impact changes for general practice, and the national steering group established early this year is now being asked by NHS England to lead its development and roll-out. In my personal life, I have seen a change from colleagues calling me ‘the vicar’, whose work had dubious relevance to real general practice to becoming the national clinical champion for social prescription, NHS England. 

This concept is a beast that can no longer be put back in its box. It is not part of some transitory government policy or initiative, nor is it part of a cunning plan to do the NHS on the cheap. It’s something that has been developed by frontline clinicians and their patients all over the UK, who are recognising the limitations of our current health service model and want to do something that makes a meaningful change to the lives of our patients and the health of our communities. 

It represents a reduction in oppressive workload and a change in job description for GPs, a new hope for patients, who really want jobs, social support and meaning rather than antidepressants. It represents a Trojan horse for developing community resources and capital – the holy grail of a health-creating community rather than, as present, communities that make us ill. 

ThinkstockPhotos-85447332 edit

Challenges to social prescription 

Two things stand in the way of social prescription. The first is a cry for ‘more evidence of effectiveness’. There is evidence in Rotherham CCG and more recently Gloucestershire CCG – both of whom have embraced social prescribing for all patients and are showing real savings for the NHS. To others it is ‘just plain common sense’. If the NHS wants to wait for definitive double blind placebo-controlled evidence, then this can only be a means of delay and a hypocritical one at that, because the NHS has never really proceeded along these lines anyway, when it didn’t want to. 

Research is important, but mostly to find out what aspects of social prescription work best rather than whether it is itself a viable concept. The other problem concerns risk and, with the NHS owing half its annual income in litigation, this is understandable. Nevertheless, if we are going to hand health and healthcare to patients and communities and involve a vibrant volunteer and voluntary sector, then we will need to get our act together in terms of trusting non-professionals and non-clinicians to help co-produce a financially sustainable NHS.  

The progress of social prescription should be seen as a litmus test of whether the FYFV is rhetoric or reality. It will test patients, clinicians and policymakers alike and challenge the vested interests of a visibly ineffective status quo. It could represent the last open battle between the peasants and patients of the frontline of the NHS and the barons of professional and organisational self-interest. New hope versus stick in the mud.  Where do you belong?

Tell us what you think – have your say below or email opinion@nationalhealthexecutive.com

Comments

Dr Pete Sudbury   13/01/2017 at 08:11

This is absolutely right. The social and behavioural determinants of health are far more powerful than any medical ones. The most powerful interventions are almost always public health ones. When we know that walking briskly for 10 minutes a day reduces your chance of dying by 20%, but sitting still for 11 hours a day increases it by about the same amount, we need to be intervening positively to change the way people live. The combination of right amount of exercise, the right diet, are as powerful as stopping smoking in the prevention of disease. We need to do that not only on an individual basis, but societally. One of Kaiser's mottos is "make it easy to do the right thing": streets need to be easy to walk in, and healthy food easy and cheap to find. That's going to be controversial, with a government that removed all reference to junk food from the public health strategy, presumably after intense lobbying from the sugar, salt and saturated fats lobby. The fear of practitioners will be that it extends the role of "healthcare" way beyond what we conventionally think of as "medicine". In reality, we have spent decades medicalising behavioural and social problems, (mass prescription of statins being a great example), and we should see social prescription and a way of addressing the cause rather than just the symptom.

Mona Sood   06/02/2017 at 13:10

Social prescribing is a no-brainer: apart from its intrinsic value it can challenge the patient perception that there is a pill for every ill, and encourages people to take control of their own health. There is however a question about sustainability of the intervention if there is not extended open-access to a service once referred, and this is where the inverse care law rears its ugly head once more (gym schemes that come to an abrupt end after a given number of sessions, for example). NICE has issued guidance on individual behaviour change (the reviewed version is expected in August) so we know how to build quality into a system. A national commissioned suite of interventions from PHE would be manna from heaven. Perhaps extend the DPP to all, eventually?

Vanessa   15/02/2017 at 13:42

I thought it was a lie when I saw Sarah Colmes, Susan and so many other comments on how Dr Garuba7demons helped them in bringing back their lovers, so I also decided to contact Dr Garuba7demons I was surprised after some days my husband that have left me and our kids for about a years now started calling me pleading for forgiveness, now we are back together in happiness and as one lovely family. I was so amazed that this could really happen. If you or anybody you know out there is having similar problem, I believe Dr Garuba7demons can help you, contact him on. Call/Whatsapp- +2348141263228 Email Id :- drgaruba7demons@yahoo.com Website: http://blackmagicspellcaster.zohosites.com

Add your comment

 

national health executive tv

more videos >

latest healthcare news

Lack of progress around growing waiting list could fuel surge in negligence claims against the NHS

22/03/2019Lack of progress around growing waiting list could fuel surge in negligence claims against the NHS

A rise in negligence claims against the NHS has been predicted by the government’s spending watchdog as it warns that “insufficient p... more >
Department of Health announces day surgery shake-up in Northern Ireland

22/03/2019Department of Health announces day surgery shake-up in Northern Ireland

The Department of Health (DoH) has announced “radical plans” to shake up day surgery across Northern Ireland. Thousands of routi... more >
‘Impossible’ for healthcare trust to remain open with 280 jobs set to go

22/03/2019‘Impossible’ for healthcare trust to remain open with 280 jobs set to go

A 150-year-old private health trust has announced it will have to close, with all services and 280 staff expected to be lost. All Hallows He... more >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Personal Health Budgets: empowering individuals

20/03/2019Personal Health Budgets: empowering individuals

Jon Baker, PHBChoices director at NHS Shared Business Services (NHS SBS) believes that the extension of Personal Health Budgets (PHBs) is a great opportunity for clinical commissioning groups (CCG) to expand and improve care provision – provided that the right infrastructure is in place. The personalisation agenda is transforming our NHS as we continue to migrate from a one-size-fits-all model of care towards care provision that i... more >
read more blog posts from 'the scalpel' >

interviews

How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now bey... more > more last word articles >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

health service focus

Aesop Institute 2019: for health and arts professionals

20/03/2019Aesop Institute 2019: for health and arts professionals

Aesop Institute 2019 is a continuing professi... more >
Old lock, new key? Sizing up the NHS Long-Term Plan

18/03/2019Old lock, new key? Sizing up the NHS Long-Term Plan

Tom McCarthy, managing partner at Niche, size... more >