Social Prescribing - an alternative to medication?
Social prescribing started in the 1990’s but it is only recently that it has started to be rolled out nationally. The approach is, for instance, a key feature in the Mayor of London’s Health Inequalities Strategy and is also being advocated by the Mayor of the West Midlands, where cycling and walking are to be on “prescription” to increase local wellbeing and health.
So what exactly is social prescription?
Social prescribing aims to deliver a new holistic approach to health and wellbeing which emphasis the importance of preventing ill health. The scheme, which was introduced as an essential feature of the NHS Universal Personalised Care model, expands the options available for GPs and other community-based practitioners, enabling them to offer more individualised and non-clinical support.
People’s daily lives, concerns and socio-economic circumstances are often intricately connected to their physical and mental health and a substantial proportion of the illnesses and conditions seen in general practices have a strong social component (e.g. social isolation, anxiety and stress)1. Yet, to date, the capacity for healthcare practitioners to address social problems that exacerbate and perpetuate ill health has been limited, not least because many of the social aspects of health had been seen as beyond the remit of medical professionals. It is hoped that social prescription can help bridge this gap.
Although the concept behind social prescription is not new, it’s incorporation into the health system is. It provides a formal channel for GPs and other community based organisations to refer and connect patients (via a ‘link worker’) to a range of non-clinical services in their local communities with potential health and wellbeing benefits - such as2:
- Emotional and wellbeing support
- Employability skills
- Debt management advice
- Support to stop smoking
- Weight and nutrition advice
- Physical activity opportunities
- “Nature therapy” (e.g. gardening)
Who might need social prescribing?
Sometimes people face a range of challenges that get on top of them and they need more support than family or friends are equipped to provide. This might include:
- Bereavement or a relationship breakdown, leading to social isolation and depression.
- Physical or mental health problems that affect their ability to do the things they used to do to stay well.
- Moving to a new area and not knowing anyone locally they can turn to for help.
- The pressure of providing long term care for a partner or family member.
Without help their mental, physical and financial health and wellbeing may deteriorate, in turn leading them to become increasingly dependent on the NHS and other public services.
Benefits of Social Prescribing
As the examples above illustrate, ill health cannot be solved purely by waiting until people fall ill and then treating them. The social determinants of health need to be addressed as well. Far too many people are spending too many years in poor health. However, many health conditions are not inevitable, and can be prevented or improved by lifestyle changes.
Social prescription presents local authorities, and the NHS, with an opportunity to make use of existing local resources, facilities and community services to improve the health and wellbeing of their local population. It has the potential to bring additional capacity to primary care networks. Additionally, as schemes are tailored to local health needs it provides a tool for local authorities to help address health inequalities3 – albeit by helping vulnerable people better manage their circumstances rather than by removing the underlying socio-economic inequalities that fuel health inequalities.
To patients, one of the principal benefits of social prescribing is the increased access to non-clinical support via primary care. Traditionally, primary care tends to involve time-limited appointment and finding a cure and/or treatment to specific illnesses. The introduction of social prescription model represents a gradual shift away from this traditional model as it allows GPs to place a greater focus on prevention and the underlying causes of ill health. Although the scheme is relatively new, a wide range of positive health and wellbeing outcomes have been reported. A systematic review appraising the evaluation of 86 social prescription schemes has pointed to improvements in areas such as: emotional wellbeing, quality of life and levels of social isolation4.
Another compelling aspect of social prescribing is its potential to reduce the pressure on the NHS and meet a growing demand for more person-centered support. For example, a study from the University of Westminster found that social prescribing resulted in an average 28% reduction in demand for GP services from patients who had been referred to a social prescribing initiative5.
Some challenges and limitations of social prescription
- At the moment there is limited validated evidence on the effectiveness of social prescription. This is partly because it can be difficult to capture the change schemes have made in individual’s wellbeing in a survey in a way that is statistically significant (generally owing to differing qualitative outcome measures, with no control groups for comparison and small sample sizes). As evidence often influences how funding is allocated, this could be problematic in the future.
- Social prescription initiatives vary in size and the choice of specific focus areas is left to local discretion. Social prescription may therefore involve some degree of “postcode lottery” and some local schemes are more far-reaching than others.
- The scheme depends on the capacity and resources of small community groups and charities, who often provide the services prescribed. These local organisations typically rely on grants and fundraising events for their survival. This has proved to be especially challenging for many during the pandemic. For social prescribing to work, local community groups and organisations need to be financially supported and effectively embedded in the local service network.
- While social prescribing can help to improve the health and mental wellbeing of participants, it isn’t a substitute for psychological therapy. Social prescribing schemes should be regarded as a support that can be recommended along side other healthcare and psychological services and not as a ‘quick fix’. Furthermore, while social prescribing may help to alleviate some of the pressure felt by the NHS, it cannot be seen as a solution to deep-rooted, systematic problems in the welfare system.
Case study – The Rotherham Model
A number of social prescribing schemes have provided valuable insights into how social prescriptions can bring positive outcomes for patients. Voluntary Action Rotherham (VAR) is a good example of this.6
The pilot programme, which offers 2 different social prescription schemes, the Long-term Condition (LTC) Social Prescribing and the Rotherham Social Prescribing Mental Health (MHs), has been independently evaluated from the start. Some emerging findings:
- Patients benefiting from additional support and advice through a social prescription scheme have reported significant improvements in wellbeing and health (over 80% improvements for LTC patients and over 90% for mental health users).
- Reduction in primary care use. LCT scheme patients saw a 6- 11% reduction in non-elective impatient stays and a 13-17% reduction in A&E visits. MH patients saw a 50% increase in discharges to services (for patients eligible for review).
It remains to be seen if such schemes can reproduce these results in different contexts across the UK – but the results so far suggest potential. Social prescribing doesn’t address the underlying social determinants of health, so has a limited role to play in tackling health inequalities. However, it may provide practical support for some of those most vulnerable as a result of health inequalities.
Paulina Stroud, June 2021
1. Marmot, M., Goldblatt, P., Alllen J. et al. (2010) Fair Society Healthy Lives (The Marmot Review), Available online at: https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review
2. NHS (2021) Social Prescribing, available online at https://www.england.nhs.uk/personalisedcare/social-prescribing/
3. Islam MM. Social Prescribing-An Effort to Apply a Common Knowledge: Impelling Forces and Challenges. Front Public Health. 2020; 8:515469. Published 2020 Nov 27.Avialiable at : doi:10.3389/fpubh.2020.515469
4. Chatterjee HJ, Camic PM, Lockyer B & Thomson LJM (2018) Non-clinical community interventions: a systematised review of social prescribing schemes, Arts & Health, 10(2): 97–123. Available online at: https://www.tandfonline.com/doi/full/10.1080/17533015.2017.1334002
5. Polley, M.J. and Pilkington, K. (2017). A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications. University of Westminster. Available online at https://westminsterresearch.westminster.ac.uk/item/q1455/a-review-of-the-evidence-assessing-impact-of-social-prescribing-on-healthcare-demand-and-cost-implications
6.Rotherham Social Prescribing, Janet Wheatley, Chief Executive, Voluntary Action Rotherham, Available online at: https://www.kingsfund.org.uk/sites/default/files/media/Janet_Wheatley.pdf