Plan to expand social prescribing in bid to tackle health inequalities

Social prescribing could become routine practice for GPs in London under the mayor's new health inequalities strategy for the capital.

London's City Hall (Photo: iStock)
London's City Hall (Photo: iStock)

London Mayor Sadiq Khan said he wanted to expand social prescribing in primary care and would encourage commissioners to use powers which could favour small, local and non-profit providers for community health services.  

NHS England’s national social prescribing champion, GP Dr Michael Dixon, told GPonline the mayor’s plans were ‘ahead of the game’ and could reduce GP workload and improve job satisfaction. 

Mr Khan has begun consulting on the ten-year strategy which outlines a series of objectives for reducing health inequalities in the capital.

The mayor said is was ‘unacceptable’ that a person’s wealth and background had such a major effect on their health.

London has the widest health inequalities in England. Death rates from preventable causes are twice as high in the Tower Hamlets as in the neighbouring City. Women in the East End are in poor health for an average of 37% of their lives, compared with 15% for men in Enfield. 

Social prescribing

Among a series of objectives, the mayor said social prescribing should become a ‘routine part of community support across London’ in both primary and acute care. 

The strategy said that around 20% of patients consult their GP for what are social rather than medical issues. It said social prescribing could be used to get get non-medical support to patients including community activities like walking groups, employment support, housing and debt management. 

The strategy document added that community support is often provided by local authorities, charities and voluntary sector organisations which could be ‘catalysed’ by an expansion of social prescribing. 

It said that these services are often under pressure from public sector spending cuts and the growing demand and complexity of services. In order to support services and provide best value, it added, commissioners should considering the Social Value Act 2012 which allows public sector commissioners to put social benefit at the centre of procurement decisions, which can benefit bids from voluntary or public sector organisations. 

Dr Dixon, a long-time champion of clinical commissioning, said the act was ‘underused’ but could enable the creation of locally-owned services ‘committed to the long term good of the community rather than the interests of the providers themselves’.

The mayor’s strategy document also called for more joined-up use of premises to help community groups such as sharing with leisure, sports and health services. Fire stations, it added, could be used for memory clinics for dementia patients, stop smoking clinics or mental health services for children and young people. 

Aims of the strategy include helping children have healthy places in which to learn, play and develop; supporting reducing mental health stigma and reducing suicide; a healthier environment; better prevention and self-care; and healthier lifestyles.

Reducing inequalities

Mr Khan said: ‘Leading a healthy life should not be determined by where you live - it is unacceptable that a person’s wealth, background and postcode has such a major impact on their overall health. I want every single Londoner to be able to enjoy a healthy and happy life.

‘London has the potential to become one of the world’s healthiest major cities. If we are to achieve this ambition, we must start by reducing some of the massive inequalities that exist in the capital.’

Dr Dixon said: ‘I am very impressed by the ambition and clear thinking behind mayor's new inequalities strategy. London is ahead of the game with social prescription - a few areas are now providing universal access for patients and GPs - and it is fast becoming the leader in the field.

He added: ‘Social prescription must make best use of all community volunteer and voluntary capability. Simply handing it to the large organisations - as commissioners frequently have - is against the grain of social prescription, which must be developed locally, organically and with maximum involvement of the whole community. It is not simply about providing a short-term service to patients but also about developing long-term community infrastructure that will enable us to grow health creating communities. 

‘For clinicians, these proposals provide something special. Help via social prescribing to reduce workload directly because patients can access the social prescription and reduce the need for clinical time but also indirectly because patients helped by social prescription have been shown to use GP services less.’

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