NHS England has this week announced plans to recruitment 1,000 ‘link workers’ to help patients live fitter, healthier lives and combat anxiety, loneliness and depression.
Around half of GP appointments are not directly related to medical conditions and growing evidence shows that referrals to community services such as exercise or art classes – known as social prescribing – can boost health and wellbeing.
The recruitment of 1,000 link workers is part of NHS England’s plans to expand social prescribing. Link workers will be able to give people time to talk about what matters to them and support them to find suitable activities that are a better alternative to medication as part of a step change in the provision of ‘personalised care’.
The blueprint for Universal Personalised Care, which will also free up GPs to deal with patients who really need them, is due to approved by the NHS England Board later this week.
The NHS Long Term Plan will see GPs surgeries big and small will work to support each other in around 1,400 Primary Care Networks covering the country, with each network having access to a social prescriber link worker and NHS England agreeing to fund their salaries in full.
By 2023-24, social prescribers will be handling around 900,000 patient appointments a year.
Dr Nikita Kanani, NHS England’s Acting Medical Director of Primary Care, said: “We will be recruiting a substantial number of people to support general practitioners over the next five years, to help ease the workload and pressures that we know general practice is under. But we see the network of social prescribers as a fundamental change to the way primary care operates and vital to the future. Recruiting social prescriber link workers will be a priority target as a part of the Universal Care Plan.”
The expansion of social prescribing is backed by family doctors and comes alongside plans to expand the primary care workforce as outlined in the NHS Long Term Plan.
James Sanderson, NHS England’s Director of Personalised Care, said: “A further 2.5 million people will benefit from personalised care by 2024. A one-size-fits-all health and care system simply cannot meet the increasing complexity of people’s needs and expectations, so we’re setting out how people who live with multiple long term conditions can expect the same choice and control over their mental and physical health that they have come to expect in every other aspect of their life.”
“Social Prescribing is an important component of the NHS comprehensive model of Personalised Care and there is emerging evidence that it can lead to a range of positive health and wellbeing outcomes for people, such as improved quality of life and emotional wellbeing. The aim is that social prescribing schemes lead to a substantial reduction in the use of NHS services, including GP attendances.”
Dr Richard Vautrey, BMA GP committee chair said: “Every day, GPs see a large number of patients with a broad range of health conditions. But often, those who come to see their GP will have complex underlying reasons for doing so, not always medical and often linked to social and domestic circumstances which affect their physical and mental wellbeing.
“Good access to professionals who can link patients to local services and activities – such as community support groups and classes – can be of great benefit to patients, actively involving them in their own care and improving their longer-term wellbeing. This should also allow GPs to focus their time and expertise on treating people’s more immediate or acute health needs.
“GPs and their teams are under a huge amount of pressure to deliver high quality care to a rising population with increasingly complex needs, and therefore it is vital, now more than ever, that patients are able to see the right healthcare or support professional for them within a reasonable timeframe. The BMA has long-backed social prescribers supporting the general practice team, and this commitment to roll them out across the country is very welcome.”
The NHS Long Term Plan is the first time in the NHS’ 70 year history when there will be a new guarantee that investment in primary, community and mental health care will grow faster than the growing overall NHS budget.
This will fund a £4.5 billion new service model for the 21st century across England, where health bodies come together to provide better, joined up care in partnership with local government.
Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said: “Often the underlying reason a patient visits their GP is not medical, yet it can have a considerable impact on their health and wellbeing. Ensuring that GPs and our teams have good, easy access to people who can link patients with classes or groups in the community and other non-NHS services, that could potentially be of far more benefit than any medicine, is something the College has long called-for, so the focus on this is incredibly welcome.”
The NHS Long Term Plan has a commitment to have 1,000 link workers in Primary Care Networks by April 2021, rising further by 2023-24, and within five years over 2.5 million more people will benefit from social prescribing, a personal health budget, and new support for managing their own health in partnership with patients’ groups and the voluntary sector.
GPs and local agencies work with patients who have multiple long term health conditions to make decisions about managing their health and care, by asking what matters to that individual, rather than just what’s wrong with them. Together, they create a personalised care and support plan that recognises the patient’s personal, social and financial circumstances can also impact their health, so connects them to care and support options in their communities alongside appropriate NHS care.
They will connect patients to community groups and agencies for practical and emotional support for a wide range of people, including those:
- with one or more long-term condition
- who need support to help with alcohol and smoking issues
- who need support with their mental health
- who are lonely or isolated
- who have complex social needs which affect their wellbeing.
Dr Marie-Anne Essam, a GP in South Oxhey, an area of significant deprivation in South West Hertfordshire, is the social prescribing ambassador for the Herts and West Essex STP.
She said: “In the 30 years I have spent as a GP, social prescribing represents the most effective, wide reaching and life changing of all initiatives to date. Sometimes I have no idea what underlies a person’s repeated presentation to the surgery.
“Sometimes I catch a glimpse of one or two social determinants of health – like seeing the tip of an iceberg. The link worker spends time and expertise which I lack, to explore with the patients the rest of the iceberg, bit by bit.
“People are enabled to use the clinical services more productively, and make personal advances which are both transformative and sustainable.”
Meanwhile, the NHS Leeds Social Prescribing scheme aims to help 5,000 people a year proactively manage their health and wellbeing and address wider issues that impact on their health such as housing issues and reducing social isolation.
GPs refer those who would benefit from more time to talk about the source of the issue and link them with wider community groups such as walking or singing or mental health support charities; people can also self-refer.
In the Leeds scheme, patients have an in-depth consultation with a well-being co-ordinator who can spend time listening to the person’s needs and goals and help put a plan together.
Commissioned by NHS Leeds Clinical Commissioning Group, the £1.5million programme also frees up GP appointments so doctors can spend more time with people with complex conditions.