This week, the RCGP launched a new manifesto that attempts to address the growing issue of loneliness in the UK. This publication acknowledges that loneliness is a serious problem, with far reaching implications, not just for individuals, but also for wider communities and GP practices.

Whilst in the past, loneliness was sometimes viewed as a trivial matter, it is increasingly understood to be a serious condition which can affect a person’s mental and physical health. There is also very strong evidence that loneliness can increase the pressure on a wide range of council and health services. It can be a tipping point for referral to adult social care and can be the cause of a significant number of attendances at GP surgeries. 

National campaign

The RCGP suggests that a national public campaign is needed to raise awareness of loneliness and social isolation across society, and to encourage everyone to get involved in combatting this ‘public health epidemic’.

Tackling Loneliness: A Community Action Plan argues that a widespread campaign is essential to educating the public, and should also encourage people to talk to their neighbours and get involved in, or start local initiatives in a bid to build and strengthen social connections throughout communities.

The action plan has come out of the College’s first-ever roundtable on loneliness; an event which saw charities, and community, voluntary and faith organisations come together to discuss how communities, including GPs, can tackle loneliness and social isolation in society.

Professor Helen Stokes-Lampard, Chair of the RCGP, said: “Loneliness is not a medical condition, but it can affect our patients’ health – some research studies estimate more so than obesity. It can also have a real impact on workload pressures in general practice and the wider NHS, at a time when the whole system is facing intense resource and workforce challenges.”

Further details on the launch of this new plan can be found here.

Social prescribing

Interestingly – and of more interest to GP practices – is the call in the Action Plan for every GP practice to have access to a funded ‘social prescriber’. These will help patients find the most appropriate support – and for quality-assured, local-level databases of voluntary sector projects and schemes to be established, to refer patients on to, and make sure lonely people are made aware of the range schemes that may best suit them.

In many cases these will be run in partnership with local councils. Responding to the RCGP call, Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said: “Loneliness is a serious public health concern which studies suggest can be as harmful as smoking 15 cigarettes a day. The potential of social prescribing to tackle loneliness is immense and is an idea whose time has come. By connecting people with local community services and activities we can improve the health and wellbeing of large numbers of people. Councils have various schemes and initiatives in place to tackle loneliness and work closely with voluntary organisations and faith groups to support vulnerable people in the community.”

The detail

Social prescribing – sometimes called community referrals – is a means of enabling primary care services to refer patients with social, emotional or practical needs to a range of non-clinical services. The prescriptions can include referrals to everything from arts groups and volunteering to activities that involve physical exercise, such as gardening and dance clubs. They can also involve simply putting people in contact with services that can provide help and advice with issues such as debt, benefits and housing.

According to the NHS, there are four common social prescribing models:

1. Referral to a commissioned ‘one-stop connector service’
2. Collaborative Practices: GP surgeries as community ‘hubs’, invite citizens in to work collaboratively, as ‘health champions’.
3. In-house ‘community link workers/ navigators’ – employed by GP Practices.
4. Active Signposting: ‘Care Navigators’ in GP practices, having different conversations with patients, signposting them to community support, as well as pharmacy, physiotherapists and care providers.

Most schemes have a link worker or navigator who GPs refer patients on to and they organise the social prescription, but there are examples of doctors referring patients directly on to an activity. Commonly prescriptions are for a set length of time, between eight or 12 weeks with a structured follow-up once that is complete. There are, however, examples of schemes that have more open-ended prescriptions and in many cases patients end up keeping up their new activity once the prescription is complete.

It could be argued that councils have three important roles when it comes to social prescribing – and GP practices can lean on them when utilising social prescribing. Firstly, with their responsibility for public health, they may be running some of the non-clinical services that social prescribing schemes can refer to. Secondly, through health and wellbeing boards they have a strategic role in getting the NHS to sign up to social prescribing and, finally, there are some councils which have become the social prescribing provider or are funding them.

An example of social prescribing

There are several examples of GPs and councils working in tandem on social prescribing, one of which we’ll highlight here, courtesy of the Local Government Association.

Cotswold District Council: working alongside GPs

Cotswold District Council’s social prescribing service enjoys a close working relationship with the area’s GPs – its coordinators work alongside them in their surgeries.

For half a day a week the social prescribing team is located in each of the GP practices taking part. It has ensured the service has become properly embedded within general practice and has helped provide a speedy, face-to-face service to residents.

“We felt it was the best place for the service coordinators to be,” says Sarah Clifton-Gould, the social prescription hub coordinator. “The GP practice is somewhere that patients trust and feel comfortable and it means they can provide face-to-face assessment. But it has also ensured a good relationship develops with GPs. That is key. They are the ones referring into the service after all. When a GP or practice nurse sees a patient they think might benefit from the scheme they fill out a social prescription which is then passed to me or one of the others.

“We spend time with the patient, find out what they need and then connect them with the services, support and clubs. We then follow them up afterwards to make sure the prescription is working. For those who are housebound, the officers will come out to them and they also accompany patients along to their first activity if needed.”

The service was initially launched in two GP surgeries, before being extended to another two. More than 200 people have been helped during this period for issues ranging from bereavement and caring responsibilities to isolation and loneliness. They have been referred on to a range of activities and services, including befriending schemes, singing groups, exercise classes and walking groups.

An evaluation based on questionnaires found that, on average, patients reported a 22% increase in wellbeing, while GPs recorded a 9% drop in appointments among those given a social prescription.

GPs are full of praise for how the programme is working. Dr Helen Bromwich, one of the doctors who uses the scheme, says it has given her practice a new dimension in terms of what they can do for their patients. “GPs can prescribe medicines or refer patients to specialists, but there are often times when problems go beyond medical issues and there is just not enough time available to delve deeper during routine appointments. “Social prescribing has given us the option of referring patients to meet those other needs and hopefully improve their health and wellbeing.”

Social prescribing is a powerful tool for GPs that can ease pressures on appointments while also delivering excellent care, and there are numerous ways to do it – more information on how it can be used to tackle the loneliness problem can be found in this document from the LGA. The RCGP Action Plan can be accessed here. It’s power is highlighted by the fact that it’s one of the 10 high Impact Actions named in the NHS Releasing Time for Care initiative – something we’ll be covering elsewhere on Practice Index over the coming months.

Have you utilised social prescribing in your practice? Was it successful? What lessons can you share with your fellow practice managers? Comment below or head along to the Practice Index forum thread here.

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