Why social prescribers have huge potential in general practice

Social prescribing has the opportunity to create a shift in healthcare to focus on what is right with us rather than what is wrong with us, says Dr David Smart. He argues that this can make GPs' jobs more enjoyable and help reduce demand on general practice.

Dr David Smart
Dr David Smart

Like other primary care networks (PCNs) across the UK, those in Northamptonshire are loooking to employ social prescribing link workers.

This is part of NHS England's plans under the new GP contract to increase the number of trained social prescribers working in general practice. Each PCN will receive funding to cover the full cost of employing one social prescriber this year and additional social prescribers in future years of the deal.

Northampton Health and Care Partnership is currently recruiting social prescribers into 16 new primary PCNs across the county. This is the first time that GP practices have come together to promote this new NHS role and it’s hoped these new social prescribers will help with workload pressures.

As a GP that has promoted positive wellbeing for the past 10 years, with benefits to myself and my patients I’m optimistic this role has the potential to dramatically change how we treat patients and how we deliver primary care services.

Emerging evidence suggests that social prescribing can improve people’s health and wellbeing and reduce workload for healthcare professionals and demand for secondary care services.1

Reducing pressure on GPs

We know that demand for primary care services is escalating at the same time as whole-time equivalent numbers of GPs are decreasing. This is clearly unsustainable. GPs are overloaded and we are just about on our knees. 

There is now a great opportunity to restructure primary care. Around 15% of consultations are for psychosocial problems that do not need the skills of a GP and could be managed by community resources, in many cases with better outcomes.

Every practice has people with complex socio-economic problems, but with limited time to spend with each patient there isn’t time to understand what help they may need and know where to direct them.

However, changing this situation requires both a change in the behaviour of patients and behaviour of GP practices. Social prescribing has the opportunity to create a shift in healthcare to focus on what is right with us rather than what is wrong with us. Personally this has made the last 10 years of my job much more enjoyable and productive.

The focus is to change the dynamic of patients’ dependence on general practice and to increase the offer of community resources, including voluntary groups and organisations, as an alternative to making a GP appointment, and therefore increasing patient empowerment.

Health benefits

The social prescriber will also keep up to date with all the services available locally, which can change weekly and are virtually impossible for GPs to keep track of.

This is not fluffy stuff and it’s something we’re passionate about. Changing people’s behaviour so they eat more healthily, exercise regularly and stop smoking can make 40% difference to health outcomes, whereas the NHS makes about 15%.2

We also know that people with positive mental wellbeing have a 50% reduction in the chance of catching a cold3 and a 50% reduction in the risk of cardiovascular events.4

Increased personal actions could both improve remission rates and reduce recurrence for common mood disorders. But the role isn’t just about signposting people to services; it is about ensuring they get the right support from relevant community resources and managing that process.

We believe that social prescribing could be key to improving people’s happiness and wellbeing in Northamptonshire and helping them flourish. Part of this is also developing a framework for promoting happiness, something we are at the forefront of in Northamptonshire.

Happiness is not a static state and the evidence from neuroscientific research is that, thanks to the neuroplasticity of the brain, we now know that by taking intentional activity we can (if we practice regularly) lay down new neural pathways associated with the skills of happier living.

Promoting happier living

In Northamptonshire we are promoting the '10 Keys to Happier Living' from the charity Action for Happiness to our patients and to our GPs to increase their resilience.5 This is used as a framework to underpin wellbeing across the county as we know how effective this can be, particularly for people with mild depression.

We will be using Action for Happiness’s evidence-based approach in two PCNs covering 50% of Northampton to promote social prescribing. This will give clear actions for patients to take in their own lives and clear focus for GPs to know what to offer as a 'prescription'.

One example of how effective this can be is a patient who came to see me who had been through mental health services for two years. I went through 'My Wellbeing Action Plan' which is a list of resources and websites. His comment to me was that in 10 minutes I had given him more information than he had in two years. He had wanted to know how to help himself.

Another patient came to see me describing how initially angry he was after I gave him a book prescription and wondering how this was going to help him. On reflection, he realised that the problem was his problem and something he needed to solve. He then addressed this, with a significant improvement in his mood.

Social prescribing is a hugely important and much-needed role which will make a big difference to patients and general practice. The recruitment drive across Northamptonshire will create a valuable network of social prescribers who can link up and share information across the different PCNs.

This joined up approach will allow PCNs to work more closely and ensure patients are referred to the right services. We hope other PCNs in the UK will follow our lead and work together to recruit social prescribers.

  • Dr David Smart is a GP partner at Leicester Terrace Health Care Centre and has promoted positive wellbeing for the past 10 years. He is the lead for mental health and wellbeing at the General Practice Alliance (GPA) Federation in Northampton, which covers three PCNs.

References

  1. Social Prescribing. BMJ 2019;364:l1285 Available at: https://www.bmj.com/content/364/bmj.l1285
  2. McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff 2002; 21(2): 78-93.
  3. Cohen S et al, Positive emotional style predicts resistance to illness after experimental exposure to rhinovirus or influenza a virus. Psychosom Med 2006;68(6): 809-15.
  4. Boehm JK, Kubzansky LD. The heart's content: the association between positive psychological well-being and cardiovascular health. Psychol Bull 2012;138(4): 655-91. doi: 10.1037/a0027448.
  5. https://www.actionforhappiness.org/10-keys-to-happier-living

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