Earlier this week, the Prime Minister launched the UK Government’s first Loneliness Strategy, designed to tackle what Theresa May described as one of the greatest public health challenges of our time.

The headline news from the Strategy is that all GPs in England will be able to refer patients experiencing loneliness to community activities and voluntary services by 2023. And that can only be a good thing – three quarters of GPs surveyed by the Government said they are seeing between one and five people a day suffering with loneliness, which is linked to a range of damaging health impacts, like heart disease, strokes and Alzheimer’s disease. Around 200,000 older people have not had a conversation with a friend or relative in more than a month.

Social prescribing

The new policy brings into the spotlight the idea of social prescribing, bolstering the opportunities GPs have to direct patients to community workers offering tailored support to help people improve their health and wellbeing, instead of defaulting to medicine. For example, as part of the long-term plan for the NHS, funding will be provided to connect patients to a variety of activities, such as cookery classes, walking clubs and art groups, reducing demand on the NHS and improving patients’ quality of life.

The Strategy, which can be read in full here, also sees some interesting partnership initiatives. One of those will see the Royal Mail run a new scheme in Liverpool, New Malden and Whitby that will see postal workers check up on lonely people as part of their usual delivery rounds. Postal workers will be speaking with isolated people to help link them up with support from their families or communities if required.

Social prescribing and its impact on loneliness is a topic we’ve addressed before on the Practice Index Blog – our post on the subject can be found here.

Lack of detail

While the Strategy has been widely welcomed, a number of ‘issues’ do persist.

As is so often the case with Government announcements and the current administration, some have criticised the Strategy for lacking detail. The RCGP responded by saying the Loneliness Strategy is a ‘great result’ for GPs and patients, but we need more detail on funding and how it will work in practice.

Professor Helen Stokes-Lampard, RCGP Chair said: “GPs across the country are seeing an increase in the number of patients, across all generations, who are not ‘medically ill’ but whose problems stem from social isolation, so it is very encouraging to see the Government taking action on this.

“We look forward to more detail about how the proposals will be funded and how they will work in practice. We must ensure that we have a society-wide approach to this challenge and that responsibility for the success of the Strategy does not fall disproportionately on GPs and their teams.”

Isolated groups

Other critics point to the fact that the focus is once again on GP practices acting as the focal point. Without sufficient funding, they argue, it’ll just be another job on the to-do list of already stretched practices.

The RCGP’s community action plan called for access to a ‘social prescriber’ in every practice, which will clearly help, but detailed funding information for which was lacking in the Strategy. And then there’s the proactive need to actually get out and go to people, rather than waiting for them to visit surgeries.

Ensuring services can identify and support those most in need of help with loneliness and social isolation is clearly a major challenge. While not all lonely people are socially isolated, many are, and reaching these individuals can be particularly challenging. Some populations face additional barriers to accessing services and support in their communities. Populations who are often considered ‘hard-to-reach’ include, people who are housebound, refugees and asylum seekers, and geographically isolated or rural communities. These communities are known to be at significant risk of loneliness and social isolation.

A learning report published in September 2018 by the Co-op and British Red Cross outlined how the reasons services struggle to reach some people vary. Reasons include a lack of access to appropriate transport, fewer community spaces, language barriers, and the failure of ‘word of mouth’ promotion due to social isolation. Barriers around lack of trust and confidence can also be a challenge. Physical conditions can also be a barrier – including those who are partially sighted or deaf (download our handy deaf patient access policy here).

Yet, despite these barriers, there is evidence that health services are often the only point of contact for some of the most isolated individuals. In particular, the GP is often a person’s only connection outside the home. That means establishing referral linkages through health systems and building on trust already established between individuals and their health professionals can be very effective. However, participants in learning events used to put the report together, demonstrated that establishing connections with GPs and other health professionals can prove challenging in practice, due to time pressures on these professionals and, sometimes, their lack of willingness to engage with non-medical services.

A joined-up approach is needed

While for some people health services offer a route to support, some groups – such as refugees, asylum seekers and people who are homeless – are less likely to use formal services and therefore may not be reached through these channels. There is also some evidence that men may be less likely to be in touch with health services than women.

In some areas, specialist connector services have been developed to overcome these barriers. These services can develop bespoke outreach programmes, and link with specialist professionals to ensure that excluded communities are able to access support. The learning programme found examples of connector services working with Black, Asian and minority ethnic (BAME) communities, people affected by drug and alcohol issues, women, migrants or asylum seekers, new parents and young people.

In other areas hyperlocal services, such as Local Area Coordinators, link with individuals through less formal channels, relying on their embeddedness in the local community. Such services rely on local outreach and ‘word of mouth’ to identify and connect with those who may benefit from support.

The British Red Cross Community Connector programme draws on insights from both these approaches, working on a hyperlocal basis to enable local connections. Community Connectors also establish webs of referral linkages with frontline professionals and community groups from across health and social care and beyond, and encourage self-referral through their wider outreach work, including via social media, local engagement on the local radio, in supermarkets and libraries.

Throughout the learning programme, connector services shared a range of approaches for reaching those most in need:

• In North Somerset connector services have used lists of people eligible for assisted waste collections to identify people potentially at risk of loneliness and social isolation
• In Camden a structured door knocking programme has been introduced
• British Red Cross Community Connectors have linked up with the charity’s Dawn Patrol service which offers a daily check to vulnerable individuals in the community to identify potential service users

A successful case stud

Mendip Health Connections team members are employed by the 11 Mendip GP practices and offer one-to-one and group support to anyone who is a patient of a Mendip GP and might benefit from support to improve their health and wellbeing.

Health Connectors can listen to a person’s health story and give them information about local services such as exercise classes and support groups. They also work one-to-one to assist people in setting health-related goals, network mapping and network enhancement and support people to make sustainable changes, becoming more connected and reducing isolation.

Health Connections Mendip also supports community members to get new community support groups up and running with advice and expertise from its three Area Leads.

What’s more, outreach is widened by the recruitment of volunteers from all walks of life, from taxi drivers to pub landlords, who are known as ‘Community Connectors’. Practice Index PLUS members can access an up-to-date volunteer agreement here.

The scheme has developed a ‘Mendip directory’ which lists local community resources and is linked to the GP patient record system. Health Connections Mendip has also recruited an army of over 600 Community Connectors – these community members are provided with basic information about support available locally and can signpost friends, family and neighbours to support. Further information on the scheme can be found at www.healthconnectionsmendip.org.

A good start

The above demonstrates that the Government’s much-publicised Loneliness Strategy is a good start. However, much more evidence and detail is required and, crucially, the onus must fall on more than GPs to make a difference. Local authorities, charities, outreach groups and local volunteers all have a role to play – when all of these groups come together then the potential is there to truly make a difference.

What do you think of the Loneliness Strategy? Are you already social prescribing? If so, what’s working? Let us know by commenting below or take it to the Practice Index Forum.