is there a role for social prescribing …...social prescribing represent an important opportunity...
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Imperial College lunchtime seminar–(18th Oct 2017)
IS THERE A ROLE FOR SOCIAL
PRESCRIBING GLOBALLY?
Dr. Marcello Bertotti (Senior Research Fellow)
Institute for Health and Human Development, University of East London
Steering group member of the Social Prescribing Network
WHY DO WE NEED SOCIAL PRESCRIBING?
Increasing rate of Long Term Conditions. E.g. diabetes. The
WHO (2012) estimated that in 2012 620,000 died of human
violence (war and crime), 1,500,000 died of diabetes.
‘Sugar is more dangerous than gunpowder’ (Harari, 2017).
Around 15m people in England have one or more LTCs
increasing by a third over the next 10 years (DH, 2012).
LTCs account for 50% of all GP appointments and 70% of
all inpatients bed days.
Frequent attenders to primary care: In the UK, 20% of
patients attend GP for social rather than medical reasons. It
costs the NHS £395m per year (Citizen Advice, 2016)
Persistent level of health inequality (Cawston, 2011). This
lead to long-term medical conditions and particularly affects
people in disadvantaged areas
Policy interest in social prescribing
• Model for integration across health
and social care systems
• One of the 10 high impact actions to
release capacity
• One of the emerging models
(Rotherham)
• It was proven to cut A&E, out-
patient and hospital admissions
THE SOCIAL PRESCRIBING PATHWAY
PATIENT
HEALTH AND SOCIAL
CARE PROFESSIONAL
LINK WORKER
COMMUNITY/STATUTORY
SECTOR
“Social prescribing involves
empowering individuals to
improve their health and
wellbeing and social welfare
by connecting them to non-
medical and community support services”
National Social Prescribing Network
Patients/clients
/people
Long term conditions (e.g.
diabetes)
mild/moderate MH problems,
social isolation/loneliness,
social problems (e.g. housing,
employment)
Health and social care
professionals
Mainly GP practices
and doctors but
Social workers
Pharmacies
Others: e.g hospitals,
mental health support
Coaching, motivation
Co-production with user
Knowledge about
community activities
Modes of delivery
Signposting
Referring
….Link workers, community navigators, well-
being coordinators, referral facilitators …..
Community and statutory sector
• Volunteering
• Housing and employment advice
• Psychological counselling
• Walking clubs; sport clubs
• Cook and eat sessions
• Lunch clubs
• Gardening
• Group art and dance
• Museum, books e.g. art on prescription
• Conservation
Direct referral
• GP referring
patient to
comm. Activity
• Very limited
engagement
• Limited range
of services
Signposting SP
• Soc prescriber
signposting (tel
based),
• some
engagement
(often one
consultation)
• limited range
of services
Referral SP
• Soc. Prescriber
• mixed f2f and tel,
co-production,
• in-depth service
(e.g. coaching)
• Wide range of
services
Information
only
•Leaflet in a
surgery
•No
engagement
of patient
DIFFERENT MODELS OF SOCIAL PRESCRIBING
LOW
INTENSITY
HIGH
INTENSITY
WHAT DOES THE EVIDENCE SAY?
Summary of outcome evidence
15 evaluations were analysed (out of 341)
Measured health changes at 6 months
Mental health and wellbeing mainly
All studies measured improvements in
health and well-being
However,
No evidence beyond 6 months
Only one RCT (Grant et al, 2000) but only 4
months follow-up and lack of clarity as to
whether it was SP
Evidence from qualitative studies
Much of qualitative evidence is positive
Changes in self-esteem, hope, motivation particularly when sustained through volunteering
“Best thing has been meeting new people and making friends. My mobile full up with names and numbers of friends before it was just family and doctor’s number. I was really depressed before but now really happy. Before I have nothing to do, now every day I wake I think ‘yes volunteer work!’ or ‘meeting friends!’”
Role of link worker is key to positive changes (from signposting to coaching)
“You feel able to offload if you need to, discuss your fears - it’s about not being so hard on myself and validating myself.”
Summary of economic evidence
94 projects reports
14 projects met criteria: UK
based; referral from primary
care; link worker; third
sector; demand for
healthcare services analysis
One RCT and two matched
controlled studies
8 studies conducted a cost-
benefit analysis. No cost-
effectiveness or cost-utility
analysis was found.
Summary of economic evidence
GP attendance: 28% reduction (2-70%)
A&E attendance:24% fall (8%-27%)
Emergency hospital admissions 6-33% reduction
Overall reduction in referral to secondary care (6%-34%)
Economic data - SROI £2.3 per £1 in first year
Challenges to the development of Social
Prescribing
Lack of feedback to GPs
Most users do not recognise social prescribing
Engagement of GPs: “The terrible thing is that I referred five but I
should have referred about 15 times that. Although I am very enthusiastic about it, it is hard to keep in front of your mind, and that’s the challenge!” (General Practitioner)
Local commissioners have limited funding, although some new funding is now available and 75% STPs involved – increase in discussions between CCG/LA/PH
Third sector needs investment to ensure sustainability of social prescribing. Examples of allocating funding to third sector exist (e.g. Rotherham, Newham community prescribing, Ways to Wellness)
Methodological challenges in evaluating social
prescribing Many outcomes: how do we know which is the right
outcome to measure?
Generalisability of data? What is the right method to
include a control group?
The monitoring of social prescribing is problematic.
Data collection is often patchy. E.g.
What happens to patients after they have been
referred by their link workers?
What and why we have drop outs?
Conclusions (1/2)
Social prescribing represent an important opportunity to:
Prevention (e.g. pre-diabetic), self-care/self-
management of LTCs, social problems (unemployment,
debt, housing etc)
It focuses on the bio-psycho-social model of illness
beyond anatomy and physiology
Makes effective use of the community sector
Takes forward NHS person-centred agenda
Social prescribing as an opportunity
Conclusions (2/2)
The current evidence is not yet robust enough:
Qualitative evidence show much promise, but this is not
yet followed by rigorous quantitative studies
economic analysis also shows promise but
Overall, we need studies with larger samples, over
longer follow up periods and possibly randomised
controlled studies.
Would you see this type of intervention work in other
countries?
Thanks for listening
If you want to join the mailing list of the social prescribing network:
Socialprescribing@outlook.org
For more information:
Dr Marcello Bertotti m.bertotti@uel.ac.uk
References
Dahlgren G, Whitehead M (1992). Policies and
strategies to promote social equity in health.
Copenhagen, WHO Regional Office for Europe
Cawston, P. 2011: Social Prescribing in very
deprived areas. British Journal of General
Practice, 61 (586), 350.
vi Citizen’s Advice (2016) A very general
practice: How much time do GPs spend on
issues other than health?
https://www.citizensadvice.org.uk/Global/Ci
tizensAdvice/Public%20services%20publicatio
ns/CitizensAdvice_AVeryGeneralPractice_May
2015.pdf
Harari, Yuval Noah “Homo Deus. A Brief
History of Tomorrow”, London: Vintage
World Health Organisation (2012) ”Global
Health Observatory Data Repository, 2012”
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