As the social prescribing workforce is being rapidly expanded in primary care, Dr Pipin Singh explains why the role is valuable for primary care networks and how to make it work for your practice and patients
Social prescribing has been around for some time but has recently become more widely adopted within practices, especially now that the role is being promoted and funded by NHS England as part of the expansion of the primary care workforce.
There does not appear to be a universal definition as to what social prescribing encompasses, but generally a GP or nurse will refer patients to a dedicated link worker who can assess the patient face to face, or remotely, and refer on to appropriate services.
The aim is to assess the patient holistically, factoring in their health, emotional, social and practical needs and provide a bespoke management plan that improves health and wellbeing using the voluntary and community sectors. It should allow patients to address the question ‘what matters to me?’
The concept recognises that people’s health, morbidity and mortality is heavily influenced by social, environmental and economic factors. It also aims to promote self-management and reduce dependence on medical professionals.
We have seen a big increase in austerity, childhood poverty and social deprivation over the past 10 years. It is widely recognised that a significant percentage of GP consultations are due to social problems such as housing, financial and employment issues.
Social prescribing allows patients to be directed down a path that takes into account all these social factors and formulate a holistic plan with the patient that can also have a positive impact on their physical and mental health, as well as their role in society.
COVID-19 has also led to increased mental health and social problems, particularly due to isolation, so link workers are critical right now during an ongoing pandemic to support the increased social health needs of the population.
NHS England has been increasingly promoting the approach of social prescribing, with an initial goal of employing 1,000 social prescribers through PCNs by March 2021. Funding for social prescribing link workers was introduced in 2019 in the new 5-year contract framework for general practice. This allowed each PCN to employ a link worker with full costs reimbursed.
More recently, the offer has been expanded under the 2020/21-2023/24 updated GP contract along with greater flexibility on what skill mix a PCN can appoint– based on the ‘national supply’ of available staff, NHS England suggests each PCN might employ five link workers. Extra funding was also made available to practices up until the end of January next year, to support Networks to accelerate recruitment.
The salaries are defined in line with the NHS Agenda for Change scale, with a social prescribing link worker for 2020/2021 paid ‘up to band 5’ with total costs of £35,389 (including on-costs of employment) reimbursable via the ARRS.
It is thought that, pre-pandemic, up to 20% of consultations with GPs were for social problems. Although the GP may identify these problems either at initial consult or over time, practical solutions were difficult to generate due to lack of time and often unable to follow up.
An example of this may be a patient with chronic pain with multiple comorbidities and polypharmacy who in a three-month period has attended accident and emergency, a walk-in centre, and two locums and a GP trainee at their surgery, but who has not yet had the social aspect of their care dealt with. In this scenario, the patient may have problems with literacy, debt, poor housing, poor family support – all of which are contributing to the patient’s ongoing need to seek pain relief.
A social prescribing link worker can help to address all of the patient’s problems in conjunction with the doctor, and co-ordinate support from voluntary organisations. They can follow the patient’s situation closely and support them through their journey with more direct input than the GP is able to.
The social prescriber has to work within a GP practice and, with the help of clinicians and the administrative team, identify those who would benefit from a holistic overview of their care.
They should work within the MDT providing psychosocial interventions to patients such as setting goals, signposting to other organisations, agenda setting and setting boundaries and promotion of self-management.
They should be trained in promoting motivational change and recognise the stages of change that patients go through.
They also need to be empathetic, sensitive to patient needs and have good communication skills in order to extract information that will help manage the patient. They should be trained in safeguarding and be alert to information that may need to be passed back to the primary care team or escalated to the appropriate agency.
A social prescriber would also need to be knowledgeable of the area that they serve, work well within the primary care team and be comfortable attending meetings and sharing information as needed.
NHS England sets out he minimum requirements for a Social Prescribing Link Worker employed by Primary Care Networks (PCNs), in the NHS England Network Contract DES service specification.
Evidence has suggested that social prescribing can reduce inappropriate accident and emergency attendances, walk-in centre attendances and GP consultations, but the evidence is mixed and further studies are needed.
There is increasing evidence, however, that social prescribing does get people back into the workplace and improves mental health.[2,3]
The main expected benefits of social prescribing for patients can be summarized as:
As described above the evidence for any impact on healthcare use is mixed, but from my own experience and anecdotal reports, assigning a regular link worker to a complex patient with multiple chronic physical comorbidities and social needs results in the patient becoming more empowered and they are less likely to attend out-of-hours services and the GP surgery for problems related to their conditions.
Help them to help you. It is vital to invite your social prescribing link worker to regular MDT meetings. This is the best way for them to identify patients they can help. This will also help the social prescriber identify what other agencies are involved and whether their involvement may duplicate work or cause extra steps or inconvenience for patients.
Encourage regular communication. Presence at team meetings also encourages sharing of information and the likelihood that the service will be used, as it helps other healthcare professionals within the team identify needs and potential support available. It will also enhance relationships with other team members and break down any potential barriers to communication.
If you do not have a regular MDT, ensure you introduce the link worker to your team or directly to individual team members. It is really important all your team are aware that there is a link worker available, particularly any care navigators whose roles may partly overlap.
Co-ordinate with PCN colleagues. It is important to co-ordinate with other member practices where link workers are employed across a PCN. For example, if MDTs at different practices are held the same day, a link worker could be invited at least once a month, or where there are multiple link workers you can assign them to different practices.
A regular (monthly) newsletter via email, highlighting some positive outcome case examples, is also useful to keep up their profile, and share knowledge and information about the service.
Have clear referral pathways. This can be through email, task or referral form. It is also important to have a clear and formalised process by which the link worker can communicate back to the referring clinician easily.
Make sure they feel supported. Some concerns have been raised about social prescribing link workers feeling undervalued and lacking support in their new roles in PCNs. One survey conducted last summer found 30% of link workers were considering quitting due to a lack of clinical supervision and/or support – most of them based in general practice.
I suspect much of this is likely down to poor understanding of the support and skill they can provide, such that teams are not referring patients appropriately. As outlined above, it is vital your link workers are invited to MDT meetings and kept in touch with the rest of the team.
This is all the more crucial at a time where face to face meetings are restricted. With the ongoing pandemic, practices need to come up with innovative ideas for integrating their allied healthcare professionals like social prescribers into the team.
It may not be necessary to have a formal supervision process, but it is important your link workers have a clinician they can speak to, or the practice manager, to discuss any queries or concerns. In addition, encourage link workers within a PCN to meet regularly to discuss cases and support eachother – this could involve a group on social media, such as Facebook, WhatsApp or Twitter.
You could also encourage them to join an organisation such as the National Association for Link Workers, to network with other social prescribers to share experience, knowledge and training opportunities.
Dr Pipin Singh is a GP partner and trainer in Wallsend, Tyne and Wear
1. The King’s Fund. What is social prescribing? Originally published February 2017; updated November 2020. https://www.kingsfund.org.uk/publications/social-prescribing
2. Chatterjee HJ et al. Non-clinical community interventions: a systematised review of social prescribing schemes. Arts and Health 2018; 10: 97-123
3. Public Health England. Effectiveness of social prescribing. An evidence synthesis. Published July 2019
National Association of Link Workers website
NHS England. Social prescribing FAQs
NHS England. Supporting link workers in primary care networks
Health Education England. Accredited online training for social prescribing link workers
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