Evidence
Alert

Social prescribing could empower patients to address non-medical problems in their lives

Many GP practices are exploring social prescribing, which is a way of linking patients to sources of support in the local community. Social prescribing addresses non-medical needs such as loneliness and financial difficulties. The NHS employs link workers to connect patients with local support networks. During the COVID-19 crisis, link workers may have an even greater role to play in supporting vulnerable patients who are isolated at home.

Researchers who are part of the NIHR Evidence Synthesis Working Group wanted to understand how these schemes work and in what circumstances they are most effective.

They found social prescribing schemes increase patients’ confidence, motivation and the skills to manage their own wellbeing. This may reduce their reliance on GPs. These positive outcomes were only achieved when patients, GPs and healthcare managers were clear about the value of social prescribing schemes and when link workers had sufficient time and resources to form a connection with patients, with the voluntary/community sector and with healthcare staff.

What’s the issue?

Many GPs report unmanageable workloads. But up to one in five patients seeing their doctor has difficulties which are not medical. These include poor housing, financial issues and loneliness. The question is whether the GP is best placed to deal with those concerns or if a different scheme might be more appropriate.

Social prescribing looks promising. Local agencies can refer patients to a link worker who takes a holistic approach to a person’s health and wellbeing. The link worker may suggest community groups, cultural activities or services which could provide emotional support.

The COVID-19 crisis is likely to lead to more patients reporting financial challenges, mental health problems and isolation. Good connections between primary care staff and link workers may be particularly necessary to help reduce additional GP workload and support vulnerable patients during this time.

What’s new?

The researchers reviewed 118 documents evaluating social prescribing schemes and the link worker role in the UK. Gathering this data included a search of bibliographic databases, Google alerts and Freedom of Information requests to all Clinical Commissioning Groups in England.

They found that link workers for social prescribing schemes can help patients in primary care develop a sense of belonging and confidence. These new-found skills could help them better manage their own well-being, reducing their reliance on the GP.

For schemes to thrive, link workers need to work in an environment that allows them to build a connection with the patient. That means having enough time to get to know the person, so the patient feels listened to and is able to fully open up about their unmet needs and concerns. It is important that the patient is referred to the most appropriate social prescribing options for them.

The researchers also found link workers need to have an extensive, up-to-date knowledge of local services and organisations that patients can access. This is particularly important during the pandemic as activities such as financial advice or befriending services may have to be delivered via telephone or video conference rather than face to face. Link workers will need to keep up to date with how different community assets are functioning in the current crisis.

Why is this important?

NHS England has produced guidelines for implementing social prescribing in primary care. These recommendations highlight the importance of link workers feeling supported in their role and developing the necessary skills. But this guidance may not go far enough. This research suggests more consideration of the time required to build a relationship between the link worker and patient. Additionally, GP practice staff and link workers should be supported to work together.

Social prescribing schemes are relatively new to the NHS and need the support of key stakeholders such as GPs, commissioners and primary care staff. Otherwise, patients may regard these services as a means of blocking them from seeing their doctor.

At the same time, healthcare professionals may see these schemes as a short-term gimmick, rather than something which could have value in the long term for both doctors and patients. This attitude should be challenged, especially as link workers have good knowledge of available community resources and how to access them during the COVID-19 pandemic. This role may provide support to patients in a difficult time.

What’s next?

Commissioners should explore how to optimise social prescribing in primary care and how to support connections between patients and link workers. Due to COVID-19, health and social care, and the voluntary/community sector, will have to learn to adapt to a new normal where face to face services may be limited. Research is needed into virtual social prescribing services and the circumstances in which they work best.

Further research projects should consider:

  • the best ways to integrate link workers into primary care
  • the most important skills required by link workers, including their requirements for training and support
  • the role of volunteers in encouraging patients to use social prescribing
  • the cost-effectiveness of social prescribing schemes
  • the pros and cons of virtual community schemes
  • how the link worker role should be amended during the COVID-19 crisis

You may be interested to read

The full paper: Tierney S et al. Supporting social prescribing in primary care by linking people to local assets: a realist review. BMC Medicine. 2020;18:49.

NHS England information and summary guide (2019) on social prescribing.

Bickerdike L and others. Social prescribing: less rhetoric and more reality. A systematic review of the evidence. BMJ Open 2017;7:e013384.

Drinkwater C and others. Social prescribing. BMJ. 2019;364:1285.

 

Conflict of interest

The author declared no competing interests.

Funding

This review is part of a series of reviews being undertaken by the Evidence Synthesis Working Group. It is funded by the NIHR School for Primary Care Research.

Commentaries

Study author

The review highlights that simply employing link workers within primary care will not magically reduce GP workload and increase patient benefits. Primary care staff must accept that link workers can complement medical care and ensure that patients understand how social prescribing might help them.

We are in unknown territory, in which health and social care services will have to adapt. With remote working becoming the new normal, there is a risk of link workers slipping from a GP’s radar. And as more patients struggle emotionally, physically or financially due to the pandemic, there is a danger of link workers trying to help too many people. Having regular supervision could help. Ongoing contact with other link workers, so they can encourage each other to look after their own well-being, will also be important.

Stephanie Tierney, Departmental Lecturer and Senior Researcher, Nuffield Department of Primary Care Health Services, University of Oxford

Social Prescriber

The role of the social prescriber is to provide social support and signposting which goes hand in hand with the medical needs of the patient. We support people who have one or more long-term conditions, are lonely or isolated, have mental health issues, or who have complex social needs which affect their well-being. During COVID-19, the role and pressures have changed considerably, with social prescribers taking on responsibility for making telephone and text contact with the most vulnerable.

We have relatively free rein to be creative and respond to need. We give people time, focusing on what matters to them and taking a holistic approach to their health and well-being. We connect people to community groups and statutory services for practical and emotional support. We also help existing community groups to be accessible and sustainable, and we help people to start up new groups in collaboration with local partners. We work with our client/patient and together we co-produce a personalised care plan which will help them achieve their goals.

In order to be most effective, social prescribers need to be considered an important part of the primary care team. It takes time to explain and to listen to GPs and other primary care staff to make clear what we can offer and how the referral process can work.

Sapphire McCalla, Handsworth Wood and Great Barr Primary Care Network, Birmingham

Researcher

NHS England expects social prescribing link workers to play a key role in supporting vulnerable patients during the COVID-19 crisis. The effectiveness of link worker social prescribing during the current pandemic will depend to a large extent on how well it was implemented and delivered prior to the crisis within any given primary care network. The priority of link workers is likely to be on crisis management with vulnerable people.

The aim of social prescribing will remain to improve wellbeing. But the type of support and focus may have to change significantly from pre-pandemic priorities to crisis management. The link worker role in providing practical support and being a trusted person to assist with immediate needs are important resources that still require 'buy in' from individual patients and health care professionals.

Suzanne Moffatt, Reader in Social Gerontology, University of Newcastle