It seems that the NHS is getting somewhat giddy with the concept of social prescribing, like it is something new which they have only recently discovered. There is now a National Social Prescribing Network established by the well-established and respected Dr Michael Dixon as its Clinical Champion and Co-Chair. Personally, I couldn’t be happier that the concept of social prescribing now has a national focus and team driving the agenda with the support of the University of Westminster in the form of Dr Marie Polley as the other Co-Chair. To add further kudos to its visibility, Prince Charles himself attended the King’s Fund Social Prescribing Conference held in London (aren’t they always) in May this year (2017). This one-day event explored the range of benefits of social prescribing, and how best to measure and evaluate the impact and outcomes. Pioneering local areas shared their approach, challenges and achievements, and provided practical resources for commissioners and practitioners to develop schemes in their own locality.
So, what is it and where has it come from? Social Prescribing is nothing new and as a term not loved by everyone.
The great Cormac Russell (can you tell I am a massive fan of his work, I have nothing but respect for him) in his You Tube talk ‘Health Beyond Healthcare – Engaging and working with patients and the public’ refers to the fact that the doctor cannot do everything when it comes to our health and well-being. He states that 40% of GP appointments are taken up by people who are lonely and therefore not bio-medically ill. That number of people creates a huge challenge on the NHS and its continuing dwindling capacity to meet that demand. This challenge cannot be met by simply making the GP surgery or the waiting room better (see NHS England’s GP Forward View) but by making our communities stronger. Cormac goes on to say that there is huge untapped potential in communities and that the idea of tapping into that potential can be done by community building through asset based community development.
There is significant public health evidence which supports the notion that our overall health and wellbeing is determined by 5 key drivers. These key drivers are:
- Lifestyle choices
- Our relationships/associations/ networks
- Environmental conditions
- Economic status
- Access to medical care
With reference to number 2 on that list, there is epidemiological evidence which suggests that the extent and fulfilment we get from our family, friends and community networks can add 4-5 years to our life. There is no known medical or pharmaceutical intervention which can make the same claim and yet the vast amount of financial investment in our health and well-being is though number 5 on the list, access to medical care. The time is right to stop medicalising social and political issues.It seems that the answer is for clinicians across the spectrum of health to begin to understand the value of and the role of the voluntary, community and social enterprise sector and begin to form partnerships with this sector to address and support the non-medical aspects of health and well-being. I feel the need at this stage to give a big shout out to all of my public health peers out there who will no doubt be reading this and screaming out ‘we have been doing this for years’. I wholeheartedly appreciate and applaud you and agree that you have indeed invested considerable time, energy and budget working with and across communities. But sadly, as good as public health approaches are, it is but a small piece of the jigsaw and what is needed now is an entire system approach and buy-in from all partners.
In my previous role within the NHS, I was fortunate enough to be awarded some funding from NHS England in 2013. This funding was awarded to support a programme of engaging with the newly emerging Clinical Commissioning Groups (CCGs) in the north of England (similar funding was awarded to the other three regional localities in the UK). The main objective of the funding was to engage with the CCGs to discuss the benefits of developing and embedding a commissioning strategy/approach which was based on the concept of patient autonomy (inclusive of the concept of social prescribing). I could write a book on the meaning of those two small words ‘patient autonomy’. For me, promoting, facilitating and enabling patient autonomy is a no-brainer, everyone is a winner. There is significant empirical evidence which demonstrates that patient autonomy results in better patient outcomes, improved patient experience, better quality of service and (here comes the crunch) is cost effective and saves money. What became clear, very quickly, was that the CCGs were still new and embryonic and the last thing they had time to focus on was a commissioning strategy which promoted patient autonomy and one which included a social prescribing or asset based approach.
So how does social prescribing support patient autonomy?
A person is much more than any one disease or health condition. And, each of us are individual, therefore, a one size fits all approach in terms of our own health and care does not work. In respect of medical intervention as a response to disease, ill health or an emergency the clinical community don’t always see the person from a holistic perspective but from an anatomical perspective and I can see why this may be the case. I would also add at this juncture that I am in no-way wishing to sound derogatory, the NHS has some of the best clinicians in the world, we also have some of the best emergency responders in the world and I would not have it any other way. Clearly, I am not alone in my view, as we see in the media every day, people will get up off their sofa’s and protest passionately to protect this valued national commodity.
That said, even medicine has its limits and the medical model of health can only go so far, ask any jobbing GP how many patients they see every day who are desperate for a solution to a problem which is affecting their physical and mental health. I quoted from Comac Russell earlier in this blog, stating that some 40% of patients presenting every day to GPs all over the UK are not bio-medically ill. Has anyone put a cost to this, I imagine it runs into the £millions?
One can only imagine how much money is being wasted at a time of continuing financial pressures. How much precious GP time is being utilised to take part in a patient consultation when the response to the patients presenting problems are non-medical? Providing patients with the means to begin to take control of their lives from a holistic perspective means seeing beyond their anatomical condition. The current model of response is no longer fit for purpose and it is time for change. How do we turn the rhetoric into a reality and bring about the paradigm shift which is needed to change the current model? A model which remains paternalistic and top-down, a model which takes the stand point of ‘we know best’. How do we move to a model which creates the right conditions to support patient autonomy? I often use a quote from an all-party parliamentary review paper I read some years ago which stated ‘it is time for clinicians to get down from their pedestals and for patients to get up off their knees’.
In the main the NHS still practices a paternalistic model of health and wellbeing which sees the patient being submissive and accepting of what is offered to them, even if it is not what they need. In no other aspect of our daily lives are we so submissive, if Tesco’s don’t meet our weekly food shopping needs then we vote with our feet and try Asda. If Asda stop stocking the products we need we vote with our feet again and try Aldi, and so it continues. We have choices when it comes to our weekly food shop, patient choice is not so easy when it comes down to our most valued commodity, our health and wellbeing. The NHS is struggling, this is evident to anyone who does not have their head stuck in the sand. It is no longer an option to maintain the status quo, the power base must shift, and shift quickly if it is to survive. The NHS workforce is on the brink of burnout with increasing demand, reduced funding and major recruitment and capacity issues. It is time for change, it is time to really get to grips with the value of patient autonomy and if part of embedding a patient autonomy approach is to embed a social prescribing model across primary care (as a starter for ten), then I am all in favour. For me, social prescribing is just one approach which supports patient autonomy, however, with the right model (see Wellbeing Enterprise, www.wellbeingenterprises.org.uk based in Halton, Merseyside) it does this and then some. It changes people’s lives, it builds community capacity and community confidence, it adds social value, it improves health and well-being, it creates community leaders, it promotes independence and builds social capital, it creates opportunity and can improve employment opportunities. The list is endless and I cannot find one single aspect of this approach which does not result in a positive outcome.
So, if the outcomes are so great then why is this not just common practice in 2017? We will explore the paradigm shift required across health and social care and the challenges that presents next time!
