Amanda Barrell looks at how social prescribing has been hailed as the future of health and social care – but is it the answer to the NHS’ problems? And, if so, are we ready to embrace it?
Social prescribing, touted as the bridge between health and social care, between mental and physical health, and the health service and the community, is a hot topic.
NHS England has described it as a key component of the NHS Long Term Plan and has committed to funding primary care to employ 1000 new social prescribing link workers by 2020/21 “with significantly more after that”.
“If it’s done well, it could be a really good way to engage with hard-to-reach groups, and tackle health inequality,”
Deborah Wyatt, Director of talkhealth Partnership, explained: “When the NHS was formed 70 odd years ago, it was to offer acute health services for free. That was all well and good but today we are living longer and have multiple health conditions. The NHS wasn’t set up for that.
“The burden on the system is enormous, and the model we have is not sustainable, either from a resourcing or financial viewpoint. The idea behind social prescribing is that we, as a nation, start taking more responsibility for our own health.”
This new army of healthcare workers, NHS England says, will take a holistic approach to health and wellbeing, referring people to community groups, statutory services and even apps for problems as varied as obesity or financial concerns.
On the face of it, this may seem a threat to pharma and industry, but that couldn’t be further from the truth, said David Thorne, Director of NHS Insights and Interaction at Mtech Access.
“Social prescribing has had a massive boost with the NHS Long Term Plan, but I’ve been working around it for anything up to 20 years,” he said.
“In all that time, I’ve been saying that pharma doesn’t really understand the opportunity it presents. It’s not a threat, it should be synergistic. It’s pharma’s friend.”
It is an adjunct to, not a replacement for, medication, and should always be part of a larger treatment plan, he added.
Middle-aged men at risk of diabetes and cardiovascular problems, for example, could be prescribed a gym membership and cookery classes along with a statin and a hypertensive.
“When you put that all together, you have a motivated patient who is getting all the support and encouragement they need. They are engaged, they are taking their medicine and it’s working fantastically,” said David.
There are also reputational and data collection opportunities, said Deborah, whose organisation develops condition-specific patient support and education programmes delivered via primary care.
“It’s about industry being visible and saying: ‘We make this product and we believe that it’s important to support the people who take it’. It’s made very clear to the patients we work with that the supporting company will have access to the raw, anonymised data that comes from the programme.
“It’s a way for pharma to really get under the skin and understand what impact different interventions have,” she said, adding that these insights can then be fed into strategic planning.
The problem, David said, rests with industry’s systems and processes often putting walls between pharmaceutical companies and social prescribing – walls that could prove detrimental to their long-term success.
“Pharma needs to wake up to the importance of this and respond on every level, including regulatory, training and messaging,” he said, adding that this new legion of link workers would soon become the first port of call for most patients.
“They are the key to self-management, compliance, patient information, engagement, the use of apps. Everything comes down to these people.”
The pharmaceutical industry is not the only sector ill-prepared for the roll out of social prescribing, said Sophie Randall, Director of Strategy and Partnership at the Patient Information Forum (PIF).
“If it’s done well, it could be a really good way to engage with hard-to-reach groups, and tackle health inequality,” she said.
“It’s a cornerstone of the NHS personalised care agenda and shared decision-making, but it’s quite ill-defined. What will a social prescription look like, how will people be signposted to these services and how will they navigate the system?”
There is currently a lack of clear pathways which could leave the most vulnerable unable to access such services, she added.
“I think the difficulty is that the most able people, those who can use digital media to find these things, will benefit, while others will find it a much more difficult system to navigate,” she said.
Speaking from the provider perspective, Deborah said that there certainly was an issue with getting programmes to the people who need them.
“The biggest barrier is getting the NHS to collaborate with third parties,” she said, adding that commissioning such services was currently done on a practice-by-practice basis.
Navigating the system
“We have huge problems just getting to talk to the right people, just to say, ‘look, we’ve got these programmes, we don’t want any money from you, we just want you to offer them to the end-user’.
“There’s got to be a better way,” said Deborah, calling the whole process “exhausting and frustrating”.
She welcomed the funding of the new link workers but pointed out that it wouldn’t solve her problem.
“This just moves the responsibility from the practice manager to the link worker. It needs to be done higher up so that effective interventions can be rolled out from there,” she said.
PIF is concerned about what this lack of joined-up thinking could lead to if not tackled early on. Echoing Deborah’s frustrations, Sophie said: “The new social prescribing link workers will need to be familiar with the system, with their area’s particular health priorities and what’s available locally. That’s an exercise in itself.
“We also need to ensure community service providers are trained adequately and that there is a path back to the healthcare system when someone needs it, particularly in areas like mental health.”
Another challenge to wider uptake is a lack of evidence that proves the initiatives are genuinely effective, said Stephen Jowett, IQVIA’s Director of Applied Insights, UK and Ireland.
“As with everything, whether that’s a new drug, a new pathway or a new technology, if there’s no robust evidence base, it becomes a challenge to accelerate early adoption. The sooner we overcome that, the sooner we’ll start to build momentum in terms of adoption,” he said.
Sophie and Deborah agreed, adding that without systematic measurement there was no way to understand which interventions were working or how to improve them.
“We need ways of checking the quality of what is being provided, or we could end up with huge variation in the type and quality of services available,” said Sophie.
Technology could hold the answer, according to IQVIA, which recently partnered with EMIS Health to launch EMISApp Library by AppScript. The platform allows GPs to recommend clinically validated digital therapeutics and refer patients into real world studies and, crucially, provides feedback loops.
“Thinking about how you can solicit that information from the people using these services in a more structured way is quite exciting,” added Stephen.
“There’s no reason we can’t do this in the same way that we build the real-world evidence base around the efficacy of, for example, a medicine. But to do that, you need some scale to prove the initial case, and that’s where courageous leadership in the NHS and social care system becomes so vital.”
Ultimately, everyone is agreed that social prescribing has the potential to shift the dial. With a more holistic approach, it could take the NHS from a reactive health service to a proactive wellness service, while reducing pressure on secondary care and general practice.
But quite how it will fit in with the already fragmented health service and its various stakeholders is unclear.
As with most paradigm shifting projects, social prescribing has some high logistical hurdles to clear before its benefits can be reaped.