Introduction

As GPs and primary care teams, we’re on a journey. We started in single primary care organisations, we’ve entered into collaboration with others in the Primary Care Networks, and we’re en route to becoming vital members of wider Integrated Care Systems.

Whilst the individual patient in front of us will always be our priority, we have the opportunity, both intentionally and insightfully, to deliver increasingly personalised healthcare in a way that also builds resilience in communities and addresses inequalities in population health.

Social prescribing is key to the future of the NHS in the nation, and this short blog may help you appreciate why and how, and see your part in making the future a better place for your patients, your team and your community.

I’ll be appearing on various Practice Index (PI) platforms over the next few months to talk about social prescribing and I look forward to answering questions and sharing ideas with the PI community.

Why social prescribing is good for our patients

In my 32 years as a GP, I believe social prescribing is the most transformative initiative that I have been able to offer my patients. I’ve come to appreciate that people are not defined by medical diagnoses or by the level of their wellbeing proportionate to their clinical measures. Whilst medicine plays an essential part in health, 80-90% of it is more to do with what we call the social determinants. If there are problems in the arenas of housing, finance, relationships, education, employment and nutrition, to name a few, nothing I can prescribe on an FP10 is really going to help. A social prescription, however, may lead to my patient getting exactly the kind of advice and support they need, being empowered to tackle their potentially longstanding negative circumstances and, thereafter, being motivated to engage in improving their physical health, working with primary care staff doing what they do best.

So, who makes this transformation happen? Essentially, in authentic, gold-standard social prescribing, it is the patients themselves who do this, via a therapeutic, pragmatic and action-focussed relationship with the link worker. Trust, empathy and active listening, taking the time needed to really understand the individual’s problems, longings and potential all lead to the shared development of an action plan. Goals are agreed and possible ways forward explored. Usually there are at least a handful of projects to pursue, and a range of resources, advice and community agencies are required to form the foundational work for a new and better future.

Link workers do not work in isolation. They are skilled networkers and problem-solvers. They think outside the box and, if necessary, find novel ways to help their patients overcome obstacles. They work as a peer group and are in frequent communication with local organisations on behalf of their patients and communities. They are creative, compassionate and persevering, usually having come to social prescribing from another service of some kind, where they may have seen the possibilities that would open up for their clients if they were offered this kind of personal and enabling support.

They understand that the system with its silos and criteria can let some people down very badly, and it can take a certain kindness and patience to help those people get past their cynicism, fear and hopelessness to believe the future could be better. Where people’s lives have been changed, for instance, due to unforeseen disability, bereavement or loss of employment, the social prescribing approach is an opportunity to think afresh and look at the possibilities, rather than be paralysed by the circumstances.

Why social prescribing is good for our teams

I still remember receptionists spending 2-3 hours on the telephone, usually on a Friday evening, trying to find some help for a patient in some kind of personal or social crisis which I as a GP was unequipped to address. They’d be hunting for phone numbers, finding the charity had shut down a year earlier, or that the particular patient failed to meet some entry requirements for the urgent help needed. The link worker is connected both to up-to-date databases and also relationally to the resources nearby, and is able to help not only in a crisis, but as soon as the personal circumstances become apparent that could lead to an urgent situation, putting assistance in place and helping the patient to be better able to steer themselves through future difficulties.

By inviting the link worker to be an integral part of your practice teams, your multi-professional meetings and your PCNs, you will find they are able to detect even previously hidden social health issues. They will lift some of the burden felt by the healthcare professionals who have been on the receiving end of multiple presentations, without having achieved a satisfactory outcome.

Once those social issues are resolved, there is a sense of purpose, connectedness and peace of mind. The pervasive worry of housing or nutritional poverty is alleviated, the negative behaviour patterns are replaced by enjoyable and constructive hobbies, and include volunteering, which can lead to a readiness for employment. Then the healthcare team will find that their patients gratefully engage in the medical aspects of their health, become compliant with treatment, and are motivated to address lifestyle issues and use consultation time more productively. It is a win-win for patients and staff.

Why social prescribing is good for our communities

We have priceless treasures in our neighbourhoods, including the social capital of good will, local groups and facilities which enrich quality of life and give opportunities to learn, to make friends and to give and receive. In primary care we get to know about some of it. Your link worker will shine the light on more gems around your surgery than you imagined were there and connect your patients to the very resource that will help them overcome their hardship and find joy. And, as we rebuild society after the pandemic, the link workers will help us and the local government to identify where investment is needed in our communities to support the people living there. They are fabulous field researchers, and can identify gaps in provision as well as opportunities for innovation and partnerships that will generate exactly the provision ordered. As we are trained to know which clinical services need establishing or expanding, so our link workers, through their work with patients and organisations, can identify where we need to make investment to grow resilient communities.

This, I suggest, is a key to successful Integrated Care Systems, as Primary Care Networks will be increasingly well-informed stakeholders. We will be positioned to influence the policies that are made in line with our understanding of both the inequalities and the opportunities for our populations.

In closing

There is much still to say! I hope many of you have questions that we can look to answer in the forthcoming webinars. I look forward to helping you recruit, empower and supervise your very own link workers and to build the future of primary care – which just goes on getting better – for each of our patients, as we contribute to a whole-system, whole-society approach to healthy populations. Social prescribing is really good for us all.

Dr Marie Anne Essam, GP & Clinical Lead for Social Prescribing

You can find Marie on Twitter: @marieannedoc

Practice Index Learning subscribers can join a Virtual Learning session this Friday (19th March 2021) to discover more about social prescribing. Book your place here.