SPRING Social Prescribing - Models of care and support

This social prescribing service is a way to link medical care to (typically) non-clinical, locally delivered care intervention services to reduce the stress on GP/ NHS services. Medical professionals can refer their patients to a range of activities and services, recognising that a social model of health contributes to the wellbeing of patients. The Social Prescribing Project aims to empower patients and communities, supports greater independence, reduces reliance on primary healthcare, and ultimately delivers better health outcomes for people and society. SPRING Social Prescribing follows on from a pilot project delivered by Bogside and Brandywell Health Forum (BBHF) in the Derry/ Londonderry region between 2015 and 2018. Northern Ireland’s Healthy Living Centre Alliance (HLCA) and Scottish Communities for Health and Wellbeing (SCHW) have come together as a partnership to scale up the pilot, which is the largest coordinated project of its kind.

SCHW and HCLA each represents a network of community-led health organisations working to deliver better health and wellbeing outcomes with and for local people. The Social Prescribing Project will build on their experience, as well as on many years of accumulated knowledge working with local people and in local contexts. The project is funded by Big Lottery UK and will synthesise learning from across two regions, initially for a three-year period.

The project is structured with 10 delivery partners in Scotland including rural and urban areas. There are five partners in Northern Ireland, one in each trust area representing a total of 20 delivery organisations.

Current users and outcomes

The pilot programme delivered by BBHF between 2015 and 2018 supported a total of 607 people aged 65+. Based on this pilot, the people who will most benefit from a social prescription are likely to experience one or more of the following:

• low level mental health issues
• poor social support mechanisms, social isolation, loneliness or a carer
• risk of Type 2 diabetes
• physical inactivity
• frequent attendance at primary care services
• dissatisfaction with results, referral or discharge from secondary care
• poor results with mainstream treatments
• vague or unexplained symptoms or inconclusive diagnoses
• history of alcohol/drug misuse/dependence
• chronic illnesses.

GPs and stakeholders will also benefit as the project may reduce the number of repeat visits to GP surgeries, and improve the quality of patients’ lives.

Estimated financial benefits

The substantial range of health issues from obesity and diabetes, to depression and loneliness makes it difficult to measure financial savings to the health service. Health interventions range from a small number of expensive counselling sessions, to a relatively inexpensive placement in a walking group.

Social prescribing has the potential to reduce GP attendance by 28 per cent (Polley et al. 2017). Median attendance to GP practices from social prescribing users is 8.3 per year (Carnes et al, 2015). Twenty-eight per cent reduction is 2.3 fewer GP consultations per year which adds up to £83 saved per person. For 1,000 people, the saving would be £83,000 over one year. Given that a social prescribing worker costs on average £30K, the service would almost pay for itself just on the basis of savings on GP attendance.

There could also be:

• savings on benefits
• reduction in hospital admissions
• quicker hospital discharge
• delay in admission to nursing care.

The new project has a cost-saving analysis tool built into the software.

Implementation issues

The main cultural change will be the shift from the traditional medical model of health to the social model of health. Many people who present at primary care require support that is beyond a strictly medical intervention. For example, health professionals may encounter patients suffering because of isolation, stress, or low mood. These patients need more than medicine to improve their lives.

At a time when the NHS is under increasing pressure, social prescribing is coming to the fore as an effective way to deliver quality health outcomes. Social prescribing is attracting a high level of political support, but further work needs to be carried out in order to move it from a series of isolated local projects to an integral part of the way healthcare is delivered nationally.

To achieve long-term cultural change, the SPRING Social Prescribing Project will work closely with all levels of government – especially those with responsibility for health.

Barriers and enablers for expansion

There is significant synergy between the HLCA, SCHW, and their members. It was realised very quickly that something very significant could come of a partnership approach to social prescribing.

Scaling up the Social Prescribing Project across Northern Ireland and Scotland has huge potential economic benefits in terms of saving the NHS money. For example, improvements in wellbeing, reducing hospital admissions and the need for other medical intervention.

The project will have many quantitative benefits such as sharing best practice across multiple community-led health organisations.

The project will be able to record the numbers of people attending activities and the specific impact that the activities are having on their health and wellbeing. The project will also be able to measure the impact on the quality of life of participants in the project over time.

The main challenges to scaling up are:

• the geographical distance among 30 delivery partners
• cultural, social and economic differences across communities in Northern Ireland and Scotland
• delivery partners offering different social interventions in response to cultural needs in Northern Ireland and Scotland
• different levels of support from health care professionals in Northern Ireland and Scotland
• different funding depending on council areas and health trust areas.

Case study: Social Prescribing

Service-user

Ena is 77 and regularly attended her GP in Derry having dealt with several health conditions including cancer, diabetes, angina and back pain after surgery. She needed help with improving her mobility and reducing her loneliness and depression.

Support provided

The Social Prescribing Coordinator helped Ena to join a local fitness class which she attends a twice a week.

Outcomes

Reduced social isolation, greater confidence and wider social network through the fitness classes. She also feels fitter evidenced through lower blood sugar levels. Ena now attends fewer GP appointments.