Chloë Reeves is leaving the Richmond Group this week, after more than two years of providing national programme management to our Doing the Right Thing work. With NHS England about to publish their 'definitive delivery plan' for social prescribing, she reflects on what she hopes it will (and won't) include.
‘Social prescribing’, despite its clunky name, has long seemed to be a good idea. We know that 90% of NHS interaction is with primary care, that demand is increasing and that a significant proportion of people consult their GP for what are primarily social rather than medical problems.
GPs want to help, but they don’t always know how to do so. People recognise that primary care is stretched and their GP probably isn’t best placed to help them, but they don’t know where else to go. Meanwhile, the voluntary and community sector (VCS) has a lot of practical and emotional support to offer, but it can be fragmented and hard for GPs and their patients to know about and tap into.
While not a panacea to workforce and funding pressures, when done well, social prescribing can help to fill these gaps. Staff can refer people to a ‘link worker’, who spends time helping them explore what they would like their lives to be like, what strengths they have, and what goals they could work towards to help them live as well and independently as possible. With a plan agreed, the link worker then helps each person connect into relevant networks (despite the phrase ‘getting out and about’ being so commonplace, people often want to focus on re-establishing contact with loved ones), as well as practical and emotional support from the VCS.
The crucial thing is that this connecting is about much more than giving someone a leaflet. For some people, a bit of signposting might be enough, but others benefit from being accompanied to new groups and activities to begin with - familiarising themselves with the transport route and routine, settling in and building confidence.
Another important thing to remember is that social prescribing is a time-limited service. There’s a wide range of needs that it’s unlikely to prevent or de-escalate. It’s not an alternative to social work, social care or occupational therapy. It shouldn’t be funded instead of these essential eligibility-based services, nor should it be used to restrict access to them.
Nonetheless, social prescribing can be an effective preventative service, helping to address non-medical needs before they tip into or exacerbate a physical or mental health problem. There’s no exhaustive list, but we’ve seen social prescribing support people with needs relating to work, money, relationships, lifestyle, loneliness, social isolation and housing.
This is why I’m heartened to see NHS England talking about social prescribing in the context of universal personalised care. Referrers and commissioners working with existing social prescribing services have found clinically focused access criteria to be unhelpful, as they can exclude the people most likely to benefit, including those who are lonely or socially isolated. Age-related access criteria have also proven to be limiting, especially with regard to people with stress and low mood as a result of life circumstances such as redundancy, divorce or bereavement.
While the link worker aspect of social prescribing is a time-limited service, the connections are longer-term. It’s the personal networks and practical and emotional support within the VCS that help people live as well and independently as possible. Link workers are dependent upon actually having these things available to link people to. Without them, we end up with good plans, but people who’ve been messed about and given false hope, staff placed in an uncomfortable position and money that’s been wasted on only delivering half a service.
This is why 'builders' are so important. 'Builders' work within communities to ensure relevant support is available to meet people's needs. They work with and alongside the wider VCS infrastructure (such as Councils for Voluntary Service, forums and alliances) that is also essential for social prescribing. In some areas this role is undertaken by the link workers, but in others – especially within more deprived areas with fewer VCS resources – the role has been undertaken by ‘community builders’, ‘development workers’ and similarly named roles that are dedicated to social prescribing.
Social prescribing is only feasible if this building function is adequately resourced. The link worker function is a highly skilled and important one, but it cannot stand alone. It takes time and effort to keep up-to-date with VCS infrastructure and resources, to build relationships, and to work within communities to ensure relevant support is available to meet people’s needs and goals. So I hope to see this given equal recognition within NHS England’s delivery plan.
We also need to remember that while VCS services, facilities and resources are cost-effective, they are not free. Sustainable social prescribing is dependent upon resources being made available for their development, implementation and continued running. There’s also an issue of equity here. The areas that are most deprived tend to have the least thriving VCS and the largest gap between what people need and what’s already available. Even the most tenacious builder can only achieve so much in an underfunded sector. If money doesn’t transfer into the sector, then we risk exacerbating inequalities.
Social prescribing can only be sustainable and equitable if there is a transfer of resources from the statutory sector to the VCS, in parallel with the people that are linked into the sector. I very much hope to see some funding attached to NHS England’s social prescribing delivery plan, but it must come with a clear intention that an adequate share flows into the VCS.
Finally, there is no definitive model of developing and implementing social prescribing. Each area has different infrastructure, assets and relationships upon which to build. Good foundations should be built on rather than duplicated or decommissioned and replaced. In some areas social prescribing has been / can be led by community movements, while in others the statutory sector or voluntary organisations have taken / can take a lead.
So I hope the ‘definitive delivery plan’ turns out to not actually be that definitive. Advice and guidance, learning from elsewhere, a sensible, rhetoric-free review of the benefits would all be helpful. But a prescriptive model, or a focus on one particular part of ‘the system’ owning social prescribing would be unhelpful.
Good social prescribing comes out of people working together, across the sectors, sharing power and resources, and building on what works for their area. The ambition and messaging (including on Twitter) suggests this is well understood within NHS England. I’m hopeful that Thursday’s delivery plan can do justice to the opportunity.
You are welcome to use and share our 'five essentials of social prescribing' infographic.
Doing the Right Thing is our programme to explore meaningful collaboration between the VCS and the statutory sector. The programme includes a practical collaboration in Somerset, which began in late 2016. Much of the focus of this collaboration with Somerset’s VCS and statutory sector is on sustainably and equitably scale social prescribing across the county.
NHS England has announced an ambition to expand access to social prescribing as part of its Comprehensive Model of Personalised Care, with a ‘definitive delivery plan’ due to be published on Thursday 31st January.