Social prescribing: Is community the best medicine?

Square

The effects of social prescribing and the importance of communal support in addressing social determinants of health are explored.

In an analysis of 177 GP practices in the UK, it was found that the demand for consultations had grown by over 15% within 5 years, yet within the same period, the GP workforce had only grown by 4.75%. A combination of an ageing population as well as an increase of people suffering from co-morbidities has led to a strain on the workforce, with GPs in the NHS having reported finding their jobs more stressful compared to GPs abroad.[1]

To combat the increasing strain on the NHS, the NHS Long Term Plan was made, and within one of the core values of the plan -Universal Personalised Care- lies social prescribing.

Social prescribing enables primary care professionals (GPs, nurses etc.) to refer patients to link workers from a wide range of organisations. Link workers act as the connection between primary care and community, non-clinical services connecting people to wider community support to improve their health and wellbeing.

This can take the form of a variety of activities typically done through voluntary and community organisations such as gardening, art activities, healthy eating advice and many more with the aim to help a wide range of people with their physical and mental needs. [2]

In order to explore why social prescribing is effective, the factors that can affect one’s health must be explored.

As previously mentioned in an article, there are many intertwining factors that can affect one’s health, with the Biopsychosocial model mapping out how our social, mental and physical health all stand to improve or deteriorate one another.  A similar model to this is the social determinants of health. These are long term factors that shape one’s health taking into account overarching factors like socioeconomic status, education, employment, social support network as well as your access to health care and individual lifestyle factors such as smoking, alcohol use and physical activity. [3]

Figure 5.2 The social determinants of health[4]

These factors are important in identifying health inequalities; such is reflected in the relationship between unemployment, deprivation and poor health. In 2015, within the most deprived areas, unemployment in England had increased to 8.4%, contrasting the national decrease to 5.1%. There is a Domino effect at play as a parent’s income may affect the child’s educational opportunities, in turn affecting their “future employment opportunities and income”. This can lead to an increased likelihood of living in poor housing conditions which are associated with numerous health problems such as asthma, respiratory infections and poor mental health as well as fuel poverty -which is being unable to afford to keep one’s home adequately warm- a problem that plagues 5% more households in the most deprived local authorities. The implication of this being an increased risk in cardiovascular and respiratory problems especially during colder seasons, indicating that poverty can have a direct influence on the onset of morbidities, affecting one’s quality of life and expectancy.[5]

Those living in poverty are also less likely to have access to adequate health care services, further contributing to the health inequality amongst areas of deprivation; the addition of social prescribing schemes aims to target the causes of this through the use of community- centred initiatives, taking into account the social determinants of health. [6]

A key model of this being the Rotherham Social Prescribing Pilot, a pilot scheme launched with the aim of enabling patients to access support from local voluntary and community sectors (VCS) in order to self- manage conditions as well as promote “self-help and independence”.  

The social prescribing interventions enforced included wellbeing support ranging from music sessions for people with dementia to peer support groups and “condition management programmes” to encourage self-help in aspects such as managing fatigue and pain and mental health support. Alongside these streams of support, help to access employment, education and volunteering was offered.  To measure the effectiveness of the pilot scheme, social determinants of health such as lifestyle, managing money and social support were inspected and it was reported that 83% of patients experienced an improvement in at least one aspect. Moreover, it was found that patients gained a greater sense of independence especially when managing long- term conditions, alongside this patients found themselves feeling less socially isolated, a common issue amongst the elderly. The benefits span to health care providers too, with a decrease in hospital admissions, A&E attendances as well as outpatient appointments being recorded, suggesting that the increase in community-based initiatives relieved some of the strain on the primary and secondary care services. [7]

The results of the pilot scheme served as a great indicator for how future social prescribing can serve to benefit not just the health of the community but its health care providers as well. By relieving some of the pressure on GPs, it reduces the likelihood of burnout, which doctors are at a higher risk of alongside anxiety and depression, and the onset of poor mental health. This can in turn also improve GPs’ work performance, as research has shown that healthcare professionals who are less burnt out are more empathetic. This is due to the state of being burned out leading to a decreased ability to identify important cues during patient interactions that can aid GPs when building a rapport with patients and gathering a history, leading to improved patient outcomes. [8]

Despite the many benefits of social prescribing, it cannot be used as management of severe and more complex mental and physical conditions, but rather in conjunction with primary and secondary care. However, with the Government’s promises to enable for more social prescribing link workers to be in place by 2020/21 as part of the NHS Long Term Plan, the future potential of social prescribing and, with it, the promise of better holistic care is still to be seen.


References

  1. Baird et al (2016), Understanding pressures in general practice, The King’s Fund. Available from: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Understanding-GP-pressures-Kings-Fund-May-2016.pdf
  2. The King’s Fund (2017), What is social prescribing? Available from: https://www.kingsfund.org.uk/publications/social-prescribing [Last Accessed: 01/07/2020]
  3. World Health Organization, About Social Determinants of Health, Available from: http://www.who.int/social_determinants/sdh_definition/en/. [Last Accessed: 01/07/2020]
  4. Barkway & O’Kane, The Social Context of Behaviour. Chapter 5, Psychology for Health Professionals, 3rd edition. Elsevier Australia. – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/The-social-determinants-of-health_fig1_333992804 [Last Accessed: 01/07/2020]
  5. Public Health England, (2017), Chapter 6: social determinants of health.Available from: https://www.gov.uk/government/publications/health-profile-for-england/chapter-6-social-determinants-of-health#references [Last Accessed: 01/07/2020]
  6. Public Health England, (2019), Social prescribing: applying All Our Health. Available from: https://www.gov.uk/government/publications/social-prescribing-applying-all-our-health/social-prescribing-applying-all-our-health [Last Accessed: 01/07/2020]
  7. Dayson & Bashir, (2014), The social and economic impact of the Rotherham Social Prescribing Pilot: Main Evaluation Report. Available from: https://www4.shu.ac.uk/research/cresr/sites/shu.ac.uk/files/social-economic-impact-rotherham.pdf [Last Accessed: 01/07/2020]
  8. Wilkinson, H., Whittington, R., Perry, L., & Eames, C. (2017). Examining the relationship between burnout and empathy in healthcare professionals: A systematic review. Burnout research, 6, 18–29. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534210/ [Last Accessed: 01/07/2020]

Author

Leave a Comment