Tag Archives: social prescribing

1,000 link workers to be recruited to support social prescribing roll-out

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.

 

NHS Long Term Plan signals expansion of personalised care

NHS England has today (7 January 2019) launched its Long Term Plan which includes a commitment to rolling out personalised care to five million people over the next ten years.

The plans will ensure that many more people have choice and control over their mental and physical health.

This includes the expansion of personal health budgets with 200,000 people set to benefit from one in the next five years. Around 750,000 people with a long term health condition will also receive a written personalised care and support plan to manage their condition.

Social prescribing also features significantly in the Plan and 1,000 link workers will be recruited for GP practices this year and up to 900,000 people will benefit from social prescribing and community-based interventions by 2024.

Personalised care has been made a priority in the Long Term Plan following a decade of evidence based research working with patient and community groups. Evidence shows that personalised care improves people’s health and wellbeing, joins up care in local communities, reduces pressure on stretched NHS services and helps the health and care system to be more efficient.

Anna Severwright, co-chair of C4CC commenting on the Plan, said: “It is very encouraging to see personalised care feature strongly in the Long Term Plan. As someone with multiple long-term health conditions I know the huge difference it can make when care is personalised and when you are genuinely listened to and recognised as an expert in your own condition – and your own life.

“We now have a fantastic opportunity to make personalised care a reality for many more and ensure that people get the same choice and control in their healthcare as they would expect in every other part of their lives.”

Read Anna’s blog post.

Nigel Mathers, co-chair of C4CC added: “The C4CC partnership has championed personalised care for many years and we are pleased to see the NHS Long Term Plan includes a commitment to its expansion.

“Great progress has already been made and growing evidence supports a personalised approach to healthcare but there is much more to be done to realise the ambitions set out in the Long Term Plan. The success of these plans will require support across the sector, and many organisations and groups, including professional bodies, health organisations and the community and voluntary sector have an important role to play in helping to make personalised care ‘business as usual’ for the NHS.

“C4CC and our partners are looking forward to supporting the NHS with these exciting but challenging plans.”

James Sanderson, Director of Personalised Care, NHS England said: “A one-size-fits-all health and care system simply cannot meet the increasing complexity of people’s needs and expectations. Evidence shows that people will have better experiences and improved health and wellbeing if they have the opportunity to actively shape their care and support. As local health and care organisations work together more closely than ever before, we are also seeing that individuals can be the best integrators of their own care.”

The NHS Long Term Plan can be downloaded here.

A blog post from James Sanderson highlighting how the Long Term Plan puts people at the heart of the system can be read here.

A case study highlighting how Dylan has used a personal wheelchair budget to live independently for the first time in his life can be viewed here.

‘Thank God for the NHS and Nye Bevan!’

Photo of C4CC co-chair Nigel MathersTo mark 70 years of the NHS, C4CC’s co-chair, Nigel Mathers, writes this blog post on why he owes so much to the NHS and what his hopes are for the future.

I owe so much to the NHS.

I had severe asthma as a child and without the NHS, back then in the early 1950s – in its infancy, it would have been very difficult to get a good quality of treatment.

After training at medical school, I spent my entire working life in general practice, a fulfilling and rewarding career.

And just last year it proved a life-saver after I suffered a major heart attack and collapsed in the street.

Fortunately, an ambulance crew arrived in only seven minutes and was able to resuscitate me at the roadside. I had just a five percent chance of survival and was rushed to the coronary care unit at our local hospital.

Thanks to the skill of the surgeons and the wonders of modern medical technology I pulled through and have made a great recovery with a good quality of life.

Of course, this is one of the major success stories of the NHS, survival rates from heart attacks, many forms of cancer, particularly breast cancer, and a host of other diseases have dramatically improved over the past 70 years.

Way back then, heart attack victims were prescribed prolonged bed rest, while my rehabilitation has been based around daily four to five mile walks – tough at first but necessary and now part of my daily routine.

So it is easy to see why I care so much about the service launched by good old Nye Bevan in 1948 and now having to adapt to the very different landscape of 21st Century Britain, with all the challenges that brings.

As a former Honorary Secretary of the Royal College of General Practitioners (RCGP) and as co-chair of the Coalition for Collaborative Care (C4CC), I have been campaigning to bring about the changes to the health system that I believe can help it thrive for the next 70 years and beyond.

The NHS and social care services are currently under immense pressure through a combination of an ageing population and over 15 million people living with complex long-term conditions.

C4CC believes that the answer to easing these pressures, and providing people with the high-quality care and treatment they deserve, lies in our Three Cs – Better Conversations, Co-production, and Stronger Communities and happily there is now general consensus that this is the way forward. This personalisation of care has captured the zeitgeist – ‘spirit of our times’

As I look back on my career in general practice, which spanned over half of the 70 years since the NHS started, many of us were already using or beginning to harness these key principles in our daily work.

When I started as a GP, consultations with patients lasted the grand total of five minutes, the relationship was much more formal, with nobody calling me by my first name, and conversation and interaction was strictly limited, not least because of time.

In my inner-city practice, we tried hard to break down these artificial barriers by dressing informally, having soft furnishings in the rooms and never sitting directly behind a big desk when talking to people we adopted a conversational style across the side of a desk for consultations.

It was innovative at the time, but is now seen as best practice and of course consultations can now last up to 15 minutes, giving the opportunity to get to the root of a problem, which may not require costly medical intervention.

Co-production as a notion has also been around for a long time, it was just not called it.

In the 1980s we talked about a meeting of experts, with people experts on themselves and what might work best for them, and doctors the experts because of their medical training.

This evolved into RCGP best practice around shared decision-making, designed to encourage the patient to be an equal partner in their own care, the basic principle of what is now called co-production.

I’m particularly proud that C4CC has developed a model for co-production that seems to work and which has been adopted by our partner NHS England in its planning in this key area.

Finally, we have always relied on community and the voluntary services to address the unmet needs of our patients and sometimes [sadly] to fill the gaps in health and wellbeing provision for our communities.

My practice and many others were prescribing exercise in the 1980s, organising bi-weekly walks from our surgery for those we felt might benefit.

We now call this social prescribing and whether it is running, walking, joining other community groups or simply volunteering it has been found that these non-medical referrals can relieve the burden on the NHS and tackle issues such as loneliness and social isolation, themselves major causes of illness.

So while our Three Cs may not be new, I believe they really have captured the spirit of our times and as the NHS looks to the next 70 years will play an increasingly important role in policy direction and strategy.

It’s about changing the culture – about helping people to become active participants in their own care rather than passive recipients of that care – to encourage them to be far more involved in their own care and treatment.

The staggering pace of scientific development will, I believe help play a major part to facilitate this.

Wearable technology such as Fitbits and other devices allow people to monitor their fitness and general health.

There will be far greater interaction with people and health professionals through the Internet and advances in genetic technology [eg individually tailored drug treatments] are another area that has such tremendous possibilities for everyone.

Despite the current challenges, I believe we can look forward to the future with optimism.

I know C4CC and our partners in the coalition have a key role to play in shaping that future and to lead this social movement for change in the way that we work with people to improve their care and deliver better health outcomes for all – ‘personalised care’ for all – right across our NHS.

Nigel Mathers, Co-Chair of C4CC