Social prescribing acknowledges that the provision of holistic, patient-centred healthcare must move beyond a medical model and consider the wider social determinants of health. Link workers can provide personalised support to help patients identify and achieve health and wellness goals and linkage into appropriate community services.
There is growing awareness of the role of social, economic and environments factors in determining health and health outcomes. Meta-analysis indicates that social support and social integration are highly protective against mortality and that the absence of these is comparable to, or exceeds, established behavioural risk factors such as obesity, smoking, and high alcohol consumption.
Evidence from the United Kingdom’s National Health System suggests that one in five people who visit a GP do so for reasons that are primarily social rather than medical. The coronavirus pandemic has served to highlight the impact of loneliness and social isolation on physical and mental health.
The better integration of medical and social care is essential for the increased use of home-based and community health care, for supporting innovative models of aged care, and for addressing the perennial issue of how to help people with chronic illness (both physical and mental) to better manage their conditions.
On a day-to-day basis, healthcare workers in general practice, sub-acute care, mental health services and aged care in Australia see how their patients’ need more than medical treatments, diagnostic tests and prescriptions, but struggle to deliver this. A 2016 study found that most GPs spend a significant amount of unpaid time on patient care, support and referrals. Social prescribing can help reduce pressure on general practice and other healthcare services by referring patients seeking help for non-medical issues to community based non-clinical services and using link workers to ensure that this is effectively managed.
In the UK, there is a workforce especially charged with helping patients manage the intersection between medical care and social care – the social prescribing links worker. This is a role that is not unlike that of case manager or care navigator, but they operate in primary care with a focus beyond the healthcare system.
Here’s how NHS England describes social prescribing and the role of links workers.
“Social prescribing is a key component of Universal Personalised Care.
Social prescribing is a way for local agencies to refer people to a link worker. Link workers give people time, focusing on ‘what matters to me’ and taking a holistic approach to people’s health and wellbeing. They connect people to community groups and statutory services for practical and emotional support.”
“Social prescribing works for a wide range of people, including people:
· with one or more long-term conditions
· who need support with their mental health
· who are lonely or isolated
· who have complex social needs which affect their wellbeing.
When social prescribing works well, people can be easily referred to link workers from a wide range of local agencies, including general practice, pharmacies, multi-disciplinary teams, hospital discharge teams, allied health professionals, fire service, police, job centres, social care services, housing associations and voluntary, community and social enterprise (VCSE) organisations. Self-referral is also encouraged.”
Social prescribing links workers have been in place in some parts of the United Kingdom for more than a decade (there are currently about 1500 links workers) and recently there have been efforts to boost this.
A systematic review of social prescribing schemes in the United Kingdom reported that these engendered feelings of control and self-confidence, reduced social isolation, led to positive physical and behavioural changes such as weight loss, increased physical activity, improved mental health and long-term condition management, and could provide effective coping strategies to manage relapses. Social prescribing schemes may also lead to a reduction in the use of NHS services.
The evidence base is not robust and is confounded by the variety of approaches to social prescribing and the lack of long-term follow-up of patients. But clearly this an approach worth exploring as part of needed primary care reforms in Australia.
Indeed it has been considered and discussed by a number of organisations and groups, See for example, the report from a roundtable on social prescribing held by the Royal Australian College of General Practitioners and Consumers Health Forum in November 2019. There are also at least a few pilot programs – for example, a program in suburban Melbourne delivered by a partnership between IPC Health, North Western Melbourne Primary Health Network and Brimbank City Council and Plus Social which is operated by the Gold Coast Primary Health Network ((The Gold Coast PHN website also has some useful links to evidence and references on this topic.)
The broader health impacts of the coronavirus pandemic serve as an additional driver: there are increased levels of loneliness, depression and anxiety, and concerns about whether people with chronic and complex conditions are getting the care they need – all issues that current services are hard-pressed to address.
The immediate hurdles to implementation are obvious but not insurmountable. It will require a willingness to think beyond general practice and fee-for-service to primary care and alternative financing mechanisms for the primary care team. The fact that some PHNs have already managed this should provide some guidance for moving forward. A Scottish evaluation from 2017 does a good job of highlighting the implementation problems and the need for fully integrating social prescribing into practices over a timeframe of some five years or more.
Dr Lesley Russell is an Adjunct Associate Professor at the Menzies Centre for Health Policy and a non-resident Fellow at the United States Studies Centre at the University of Sydney.