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Social prescribing
Social prescribing is about helping people to find ways to improve their health and wellbeing by linking them up with what is going on in their local area. It enables people to access services that meet their wider emotional, physical and social needs.
Together with the Healthy London Partnership, NHS England and the Social Prescribing Network for London and following engagement, City Hall has developed a draft social prescribing vision for London.
We'd love to hear what you think.
Have you heard of social prescribing before and what do you think about it? Do you know if it’s available in your area? Would you use a social prescribing service if it were offered to you?
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I've known about social prescribing for a long time as I run singing groups for the health and social benefits they offer. I have the feedback from participants to show that it makes a huge difference to people's physical, emotional and mental health, as well as helping to combat loneliness.
For a long time I've wanted doctors and other prescribers to take social prescribing much more seriously: it leads to fewer GP visits and fewer hospital admissions; and participants gain in many different ways (socially, emotionally, physically) from taking part in the various activities prescribed. The people leading the activities - like me - need to be paid as the work is part of our livlihoods: we're not volunteers. And because this kind of group participation can lead to fewer GP visits and hospital admissions, paying for social prescribing could save the NHS lots of money and time. Simple! Time to grasp the nettle. . .
Good idea, but they might have to stop cutting leisure centres, parks and libraries...
I'm not convinced that a system that relies on volunteers to provide legal, social and housing advice is going to do more good than harm. Why volunteers? And where do you think these competent, hardworking, ready-to-leap-in, financially independent volunteers, with adequate time to deal with the 20% of NHS patients who might benefit from this intervention, are hiding? Is this the retired supporting the retired? If the only way you've been able to justify this as cost-neutral is by relying on people training and becoming accredited to do what looks like a full-time job without pay, then it's not cost-neutral: it's unsustainable. People need to be compensated, generously, for supporting and aiding lonely, confused, stressed out, angry, scared strangers. Social workers are already notoriously overworked and underpaid, and we regularly see how this compromises their impactfulness: how many children and vulnerable adults slip through their fingers despite their best efforts. If you're committed to actually providing this service, effectively, it needs to be people's real jobs, with training and a salary and job security. London is already expensive and stressful to live in. There are precious few people around who have not only the time to be a volunteer social worker, but the inclination, stamina and emotional fortitude.
People are going to the doctor for depression and stress. They need real mental health care, effective and affordable legal aid, and better housing laws. Not wooly self-help apps and a cohort of extra-credit sixth-formers or well-meaning pensioners being overwhelmed by their neighbours' desperate pleas for attention and help.
I think social prescribing is a good thing, as long as it's not seen as a way to move the burden of care from the NHS and health care providers to organisations that run using volunteers and donations (e.g. that aren't necessarily stable in the long term). One thing I hear often regarding social prescribing is having someone visit their local park or green space more. This is great for destressing, mental health, social interaction and physical activity. However, parks are not free -- they require funding (funding that's been drastically cut, BTW) for maintenance and management. If enough doctors send patients to green spaces and organisations begin running activities and events in parks to meet the demand created from increased social prescribing, then added pressure gets put on parks and green spaces. People will talk about how much money was saved for the NHS, but what about the added cost of running the park? I'd much rather see people get outside, be more physically active and engage with others in their local green space, but there needs to be recognition that this does come with some cost.
Seems like an excellent idea which I would support
Social prescribing is a wonderful idea. I haven't felt the need to visit my doctor about depression or anything that got me down but, if I did, I hope I would be given a social prescription and not just pills. Why hasn't this been thought of before?
Unimpressive total lack of information about costs for Social Prescribing project.
Delightful graphics but how much did they cost?
what is the budget?
How much is that per borough?
Who is going to pay.
GPs are overloaded and so are the hospitals. Local Authorities can no longer deliver social care.
Where are these link workers etc going to come from?
Are they going to be paid?
SP sounds extremely attractive but it looks like typical USA social policy. Ie a demonstration project, never costed as universal policy. The USA approach massively fails the mass of its population. The individual project is good for showing the visitors round, but for the few not the many.
Thanks everyone for joining in this discussion.
The social prescribing approach also encourages self-referral. This is where patients refer themselves to a link worker, rather than being referred by a medical professional. The link worker takes info account the patient's needs, before connecting them to an appropriate local community group.
Would you feel comfortable self-referring? What sort of information would you need to enable you to do this?
Talk London
The NHS should not be funding the link workers, and the link workers must not be given anyone's medical information.
The only role the GP or hospital medical staff should have is when health could be damaged. The patient needs to know what is safe, what approach they should take, and so-on.
I was once sent to a hospital unit for exercise stress tests. I asked the staff, who looked like technicians or nurses, for info on exercising for heart health. They all stood there looking astonished, slowly shaking their heads. No, they had nothing. They returned to their conversation. There wasn't one single leaflet or booklet about it in the place, and nothing on local places such as sport centres.
Very many of the people who need the information have no idea where to look for it. They do not know about libraries, community centres, and so-on. Many do not use computers or iphones. The only way to ensure that those who most need the information do get it, is to get it through letterboxes. Then people have the option to self-refer. The information should advise if people should check with their GPs to see for eg what exercise classes are safe to do, if massage is safe (the perfumed oils can cause asthma or anaphylactic shock), and so-on. If you have not exercised for a decade, it is maybe not safe to suddenly start vigorous exercise. There is also a need for GPs to support older people when they start exercising more, as this can cause a lot of pain from muscle and joint inflammation. Anti-inflammatory medication can reduce the inflammation while the muscles and joints adapt. Also, inflammation is the cause of other, serious, conditions, so the medication would be protective. This is the information that people need. What is on offer locally, what is safe, what helps what (research references), how to start off, how the GP can help ease initial side effects.
I think it’s a brilliant idea for improving wellbeing, reducing loneliness and building community connections. But the groups receiving the referrals need appropriate training and support to ensure that the setting is safe, welcoming and beneficial to all who take part. They also need funding - VCS groups and organisations who take the bulk of referrals are already struggling with low resources and the value that they bring to social prescribing should be recognised and appropriately funded.
There is much frustraruin about local and national government. Many people don't really know much about it but would dearly learn with the aim of joining in and helping to make their society better and improve the conditions where they live. So I regard this proposal as a very good thing and I strongly recomend that one of the subjects for explanation and discussion is how good government can be created and used.
Great idea. Parkrun, http://www.parkrun.org.uk is free to all and has been mentioned but there are many others. The advantage of GP prescribing such activities is that they can potentially help the person choose something that is suitable as well as informing the person of what is available. A librarian, or citizens advice centre could potentially also help do this, but coming from a GP would give it more weight and people would be more inclined to try it.
Giving the person agency so they feel they are in control of their health (both mental and physical) is an important component I think.
There are also online communitues, such as openlearn, futurelearn and free apps like duolingo, for those who want to learn and share comments. Learning and mental activity is important for wellbeing, and complements physical exercise.
One person commented on the "surfeit of non English speakers"? What a great idea, centres for english tuition and conversation. I'm sure many would volunteer to help in such a good cause. Reminds me of the "mind your language" tv programme in the 70s lol, they had a great community feeling.
If you tell someone about a service, explain the benefits (and risks if any), and then let them decide for themselves if it is right for them, that is giving them agency.
Surely this is the opposite of giving peole agency?
It is a brilliant idea, but the Government needs to invest in Services that can enable that. Local authority run adult education providers are the perfect hub for community engagement and already do a lot of that work. The lack of funding over the last many years has led to a reduction in the valuable service that the providers offered. In an economy that is driven by skills and employment, the faction of the community who are furthest from the skills market, need support with first time engagement - this is good for their physical and mental well being as well as combat social isolation.
NHS needs to work with the local providers to signpost those needing social prescribtion to the right avenues. This has to be a integrated approach between goverment departments and local authoritities.
I beg of thee, do not be taken in by this insidiously devious piece of spin. Notice that they do not provide the references for the research they claim proves the efficacy of 'social prescribing'. There is no mention of the fact that funding and resources for many of the activities they suggest can be prescribed have been viciously cut, so they are less available than ever for most people who need them. Most GP surgeries have for decades had information on display about all sorts of support groups and other local community activities and services. The reality is that despite a big promotion by government of how the NHS will be aiming at prevention, they are urging GPs to cut referrals made to hospital services. The outcome is that it can take so long to get those vital tests or specialist treatment that the illness has become very serious in many cases, or has become a permanent disabilty because treatment was left too late. This 'social prescribing' is just another way of not giving the treatment that is needed, all part of the planned deconstruction of the NHS. Learn new skills? Only if you can afford the costly fees of private classes. Local community? Place-makers have planned out community interactions in local streets, preferring to swamp them with swarms of tourists and shoppers they provide with expensive bars and eateries and delicatessens with sky-high prices.
Thank you for your comments, TalkLondon. I have indeed looked at the NHS webpages on social prescribing. All these activities, support groups and so-on have been there for a long time. If you go to hospital outpatient clinics there are plenty of leaflets and notices available, informing on what is available, where to find more information, and so-on. GP surgeries usually have leaflets and posters with what is available locally. GPs have been 'prescribing' sessions in sports centres for a while now. There may well be a need to make sure the appropriate range of information is available where it will reach those who need it, and GP surgeries are a good location for this, along with other places. Other health professionals working locally, and local health centres (eg physio clinics), should also carry the information.
But there should not be 'social prescribing' paid for by the NHS. This is a smoke screen for the reality, which is that social prescribing is replacing other essential NHS funded medical and professional services, that are more effective but cost more. What's more, it is likely to exacerbate the way elderly people tend to be less of a priority for many GPs and in hospitals. People are fobbed-off with social prescriptions. Of course many people benefit from the social etc activities, and in some cases their health will improve at least for a while. But it increases the risk of patients not getting the tests and referrals that they genuinely need. The NHS is spending on social prescribing, and cutting other essential services to do so.
Hi Livehere and thanks for your comment. You can read more about social prescribing on the NHS England website, where you'll find lots of references and resources. Social prescribing will complement other approaches and could work for a wide range of people, including people with long-term conditions, people who need support with their mental health, people who are lonely or isolated and people who have complex social needs which affect their wellbeing.
Would you welcome being signposted to social activities in your local area by your doctor, health professional or others? Why or why not?
Talk London
Sounds like a good idea, something we try to do through Neighbourhood Watch. looking out for neighbours who might need help and staying in touch.
People are responsible for their own health and obtaining the support they need to obtain it. Visiting their GP is a good starting/maintenance point for this, they will receive advice on what will help them. This need not be something paid for by the taxpayer/NHS. For example walking and regular exercise, sensible diet, local available social activities (from clubs to inviting the neighbours in for a coffee, depending in your breadth of interest). A good idea which is available to people free, particularly if as individuals we reach out to those who need it.
Very creative idea!! Not heard of it before.
I was a counsellor in a medical practice many years ago, and a number of my clients were suffering from depression due to a lack of meaning in their lives. They did not know where to start!!
This initiative seems like a great start for the people I am thinking of! It will help the subjects as well as the volunteers, both can benefit from it!
I hope the initiative flourishes!!
I am more concerned over how the roads in London are being wrecked by these mad bicycle only lanes - that are empty in the evenings and at nights, causing unnecessary polution from tail-backing vehicles. Also - penalties should be firmly introduced for cyclists who do not use the lanes !
I think is a very good that the idea is been taken up as part of a health package. Communitiy organisations have developed projects in the past that very much coincide with this type of initiative, like Time Banks, in which people exchange time to help each other doing things according to their skills and abilities.
Are there resources available to support those who would explore, identify and put people in touch with their possible 'prescriptions' ?
Hi there and thanks for sharing your views. You can find out more about what social prescribing services are available in your area from your local voluntary sector service council, your local council webpages -their directories of services. Your local GP surgery may also be able to direct you to a nearby service if they do not provide one themselves.
What sort of health, wellbeing and social conditions and issues do you think might benefit the most from a social prescribing approach?
Talk London
Getting people talking to each other wherever they are in the community seems sensible. Isolation because we have a culture of keeping ourselves to ourselves, and fears due to exaggeration by the media of threats in day to day life, mean that we do not treat our neighborhood as a village. Many volunteer and low cost activities are going on all the time - and if GPs and other health professionals can be a gateway, great. We are all nervous taking the first step into something new - we need to remind others that we were once newbies at the activitiy, and be open to welcoming them.
It’s a great idea. I have planted a community woodland where I live and I’d love the NHS to prescribe patients to spend time in the wood. The local surgery hasn’t been in touch with us and probably doesn’t know of the woodland. The only downside would be the time needed to host the patients, not something I have the time, or training, to do, but if that was somehow sorted it would be great to think of the wood being used to help people get better and re-connect with nature.
It is surprising, assuming that you were able to do the usual community outreach, that the GP surgery probably doesn't know of the woodland. GP surgeries are not the only places to visit as part of the outreach - there should be a local voluntary sector office of some kind for the area, as well as schools and libraries, community centres (if you have any of the last two left after the cuts, of course).
This sounds like a great idea to combat loneliness, create support networks, promote lifelong learning and nuture a sense of community.
If you don’t get down the pub and get a good legal drink down you, the Entertainment Police will be round and you know what sort of reputation they have.
Social prescribing sounds ominous, like social engineering. It will be interesting to see just how it helps people especially people who need the help most.
The fundamental problem is that the social prescribers rely on there being resources to signpost people to for support and with so much investment going to fund social prescribing rather than support services the voluntary sector don’t have capacity to meet the increased demand on their services
As always you are over-complicating and over-engineering something so making it admin heavy. Yes social prescribing is vitally important and yes eventually it can be specially trained for (a bit like a Citizens Advice advisor) but you can already use your GP doctors and nurses. At our practice in W4 we have a therapeutic garden created with the support of the practice patient's group, the doctors can issue a "prescription" and a follow-up appointment (so people are encouraged to "buy in" to the "treatment". Patients benefit from activity, growing vegetables and fruit, sociability... Early days but we already have one good case study.
So gather together a directory of all the local resources no more than a 20-minute bus ride away, evaluate each one for what it offers (physical, mental, social, diet) and how well it offers these to different sorts of people (age-range/education/ interests). This could be done by the Locality Patient Groups in each CCG.These are an under-used force. They know their patients. Then you just need evaluation of patient needs and a hub (possibly/eventually digital) matching them to somewhere they'll fit in (SO IMPORTANT) and that's easy to get to.
Social Prescribing is all about improved quality of life, that leads to better health.
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