Social prescribing: community support for medical conditions

Medicines can treat symptoms, but restoring quality of life sometimes needs a broader approach. Lucy Trevallion explains what social prescribing is, and meets a patient who’s benefited.

Community support group meeting

Two minutes’ walk from the chaotic A12 and London tower blocks, the Bromley by Bow Centre (BBBC) is a space where verandas drip with blossoms and a converted chapel welcomes visitors. This serene place is so unlike a clinical hospital, but has become a renowned source of wellbeing support locally. 

Laura Westwick, a social prescriber from the BBBC, says: “Patients often describe a bit of a black hole when they’ve finished hospital treatment and then they’re back home. They don’t know what to do to move forward and pick up their life. We’re kind of a stepping stone to help people decide what they want and how they want it.”

What is social prescribing?

An portrait photo of a smiling elderly woman standing outdoors

The BBBC is a beacon of ‘social prescribing’, an increasingly popular way to support people with medical conditions in their local communities. A social prescription isn’t something you take to your chemist.

It is designed to boost the non-medical aspects of health – good relationships, a feeling of purpose or mental health. Patients have more say in improving their health and wellbeing, resulting in a more complete approach to healthy living. 

Does social prescribing help?

Doreen Wilson, 75, from South Yorkshire, describes taking up her social prescription, as “the best thing I ever did”. Doreen had a stroke five years ago and has atrial fibrillation. After her husband died, aged 50, she couldn’t face living on her own, and moved in with her sister.

After her sister passed away, Doreen became very depressed. Her GP recognised this and put her in touch with a link worker, who runs a weekly lunch club.“The first time I went I was nervous of meeting new people and I was very shy, but once I got used to them I was fine,” says Doreen.

The first time I went to the lunch club I was nervous of meeting new people and was very shy, but once I got used to them I was fine

Doreen Wilson

"It's funny because I worked from 15 years old to 60. I used to be a buyer for a builder’s merchant – I had an important job and a lot of staff in my care, so I shouldn’t be lacking drive or confidence.”

Each lunch club lasts two hours in a local hall, where everyone sits down to lunch, conversation and a quiz. “We all make new people feel welcome, we’re like a big family,” says Doreen. “If anyone’s not there they really notice, if they’re at a hospital appointment or on holiday.” The social prescriptions available depend on your location, but some of the things the BBBC offers are:

  • [email protected], a lively art group for older people
  • Grandparent Group, a breakfast club for Bengali elders
  • One-to-one sessions to help you manage your money
  • Help forming action plans for getting into employment

“I’d definitely recommend it to everyone,” says Doreen. “It brought me out of my depression. It’s no fun sitting in these four walls day after day and not speaking to anybody. At the time, I wanted to throw myself under a bus but wasn’t brave enough. The club stops you from getting too depressed, because you know that you’ve got something to look forward to at least once a week.”

Doreen is not the only one who’s benefited. A University College London analysis in 2015, looking at 35 different social prescribing schemes, found it gave participants increased self-esteem, empowerment, and a positive mood linked to reduced anxiety and depression.

It looked at schemes like Prescription for Learning in Nottingham where 89 per cent of participants said returning to learning improved their mental health. One participant said: “Yesterday I looked in the mirror and smiled at myself for the first time in four years.”

An evaluation of Cambridgeshire and Peterborough Arts on Prescription service showed positive outcomes for 78 per cent of patients, including increased mental wellbeing (83 per cent), and decreased social isolation (44 per cent), anxiety (61 per cent) or depression (67 per cent).

Fresh approach to healthcare

Close up of a person filling in a word search in a puzzle book

Rather than seeing a doctor, social prescribing means you’ll talk to a link worker (a health facilitator or health worker) – a non-medical professional with coaching training. Instead of a 10-minute appointment they spend about an hour with you, discussing what may help.

“For most of our patients we’ll see them for a one-to-one assessment for an hour, in the community [for example in a library],” says Laura. “It’s all about putting people in the driving seat. We’d ask what’s important to them, what they would like out of the sessions, what they are good at, so it’s all about building on their capabilities. We might then signpost or refer them to services, we might discuss a plan of action, and then we might see them again.” Laura can see patients up to six times to talk about how things are progressing.

Eight years ago Bromley by Bow GPs were part of a project for the Department of Health looking at self-care in places that were lacking information. There are now more than 100 social prescribing programmes around the country, including in Leeds, Devon, Bristol and London.

Mike Dixon, a Devon GP, says: “We realised producing information doesn’t change things, we need an in-between person who can understand the patient’s perspective and fit the necessary things into their life.”

The Social Prescribing Network, which Mike co-chairs, was set up in January 2016 to allow health professionals, researchers, academics and others to share best practice. “Social prescription is about creating a community where our hearts are healthier,” Mike says. “I would say to heart patients, this isn’t only good for you, but also helps create a community that gives a fair chance to everyone.”

Money matters

Critics may question whether the NHS should pay for lunch clubs and gardening classes. But Mike explains: “A lot of this is done by volunteers and doesn’t cost anything. Sometimes you do need to pay for voluntary organisations, and the question here is a very simple one. If it’s saving the NHS money then it’s justified, if it’s not, then it’s not. But if you go to Rotherham, they have saved 20 per cent on their A&E costs and reduced the use of secondary care by 20 per cent, by helping the 2–3 per cent that use NHS services the most.” 

In theory, the scheme could create a more integrated, sustainable NHS. Last year, Health Secretary Jeremy Hunt told a conference of health professionals: “We need to empower general practice by breaking down the barriers with other sectors, whether social care, community care or mental health providers, so that social prescribing becomes as normal a part of your job as medical prescribing is today.” Social prescribing can give GPs more options of who to refer to and could reduce their workload, as around 15 per cent of GP visits are for social welfare advice, according to a Low Commission report published in June 2015.

The future

NHS hospital in the UK

Mike hopes that within two years all GPs will have access to social prescribing. "There really is momentum at the moment," he says. "I'm getting a lot of calls to find out more about it and how different areas can do it.

"The more social prescribing gets going and people are referred to voluntary services, the more are set up locally. I've seen that in my area. Now the services that are developed are the ones that patients are calling for."

Word of mouth helps too. "I recommended it to my neighbour and she comes now," says Doreen. "It's brought us closer. Now we sit outside in my garden when it's sunny, and chat and have a glass of wine together. The social club has definitely opened me up."

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