Analysis: What does social prescribing mean for GPs?

One of the less-reported elements of Jeremy Hunt's 'new deal' for GPs announced last month was a commitment to make 'social prescribing' a 'normal part' of the job.

Dr Everington: 'I click one button, and the social prescribing team picks it up. That is critical.'

Mr Hunt told GPs that while a fifth of their time is spent dealing with patients' social problems, such as debt, isolation, housing, and employment, half of GPs have no contact at all with social care providers. 'We need to empower general practice by breaking down the barriers with other sectors, whether social care, community care or mental health providers, so that social prescribing becomes as normal a part of your job as medical prescribing is today’, he said.

East End GP Sir Sam Everington, an advisor to NHS England on new care models, says the concept of social prescribing has become mainstream over recent years.

While pioneers such as Dr Everington and his partners at the Bromley-By-Bow Centre in Tower Hamlets may enthuse over Mr Hunt’s words, others will see a promise of yet more interference by government, and more work.

Social prescribing can benefit everyone

In the run up to the general election Labour announced plans for a GP-administered home safety check scheme to identify vulnerable people at risk of hospitalisation from trips, cold or other household hazards.

Some GPs reacted with horror. ‘After attending a DIY course to put up grab rails we will be able to screw the coffin lid down’, commented one. ‘Community rehab teams take care of in home elder safety, social workers and case managers the individual's socioeconomic needs. Mr Miliband needs to understand the structure of health care delivery’, another GP said.

Last week the Low Commission inquiry into social welfare advice provision chaired by Lord Colin Low, reported services located in primary care settings could cut time spent by GPs on benefits issues by 15% and reduce repeat appointments and prescriptions. The report called on NHS commissioners to use welfare advice services to address the social determinants of ill health, improving health outcomes, addressing health inequalities and reducing demand on the NHS.

Speaking at a seminar on social prescribing organised by the Bromley-by-Bow Centre (BBBC) healthy living centre charity, to which his GP partnership is connected, Dr Everington told commissioners, third sector, housing and local authority representatives that social prescribing can benefit everyone.

Often, with the option only to refer to hospital or prescribe drugs, says Dr Everington, GPs wonder whether that is what the patient really needs. With social prescribing, he says, the doctor can take a holistic view.

The Bromley-by-Bow model is based on the conclusions of the 2010 Marmot Review commissioned by government to propose strategies to reduce health inequalities. Marmot found that around 70% of health outcomes are determined by social factors, and just 30% by clinical interventions.

BBBC has a dedicated social prescribing team which receives referrals directly from six local practices - although the CCG wants to expand the scheme to cover the whole of Tower Hamlets borough’s 250,000 population. GPs have a single referral form on their computer system populated by EMIS, from which they prescribe services such as health training, debt or legal advice, or a direct referral to a social prescribing coordinator who will either make an onward referral to an appropriate service, or meet the patient to get a better understanding of their needs.

The service has access to 1,100 voluntary sector organisations in the borough to which it can refer.

'It's such a simple idea', says Dr Everington, opening up a whole raft of support to GPs. The voluntary sector 'loves it', because it gets referrals without the costs of marketing its services. And patients 'absolutely love it' because it deals with their 'real problems'.

Dr Everington, who chairs Tower Hamlets CCG, says he loves the scheme as a commissioner because he has the ability to divert patients away from health services 'to something that's not going to cost me'.

To implement a similar social prescribing service would cost a local health economy around £200,000, which would bring returns 'in no time at all'.

The major advantage for GPs of the BBBC model, says Dr Everington, is the infrastructure of the social prescribing team which refers patients to the right service, rather than requiring the GP to find a service in a directory as with alternative models. 'I can't think in 10 minutes', he says. 'I can think, maybe there is something in social prescribing. That's as much as I can do. I click one button, and the social prescribing team pick it up. That is critical. Otherwise the experience for GPs will be you are flooded with leaflets every day and there is no way you can remember all of that in a 10 minute consultation.' The model, he says is very easy to replicate and apply.

Chairwoman of the Bromley-by-Bow GP partnership and deputy chairwoman of the BBBC charity Dr Julia Davis says that having the ability to help patients with complex problems address the social determinants makes it possible to address their health problems and creates a 'very different dynamic' between GP and patient 'because you have something genuinely to offer in terms of tools'.

Rolling out the system to neighbouring practices was achieved, she explains, by showing GP colleagues the benefits to patients. The system 'helps redress some balance in consultations' when GPs have the ability to work with other organisations to deal with a patient's problems.

'The fear always is that it is layering on more work', acknowledges Dr Davis. So making referral into the system simple for GPs is really important.

Because the programme is about long term change, Dr Davis says, there are not immediate reductions in prescribing, but it encourages more appropriate prescribing because patients are engaging better.

Consultation rates have fallen for some patients, particularly the frequent attenders and socially isolated. While better health outcomes and reduced consultation rates have been seen among those referred into self care programmes .

Commissioners and GPs across the country are becoming more interested in the benefits of social prescribing for both patients and the NHS. In one recent example, a GP provider organisation in Warwickshire reported that its scheme to create social contact between isolated older patients had slashed GP consultations by a fifth among those put into the scheme, demonstrating the potential of such an approach. Key for commissioners considering social prescribing schemes will be to convince overworked GPs not only of the benefits to patients and budgets, but to general practice as well.

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