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From isolation to interaction: learning from social prescribing

From isolation to interaction: learning from social prescribing

From isolation to interaction: developing a network, to share learning, develop outcome measures, and ensure the potential of social prescribing meets the needs of the NHS

Start Date:  Jan 2016   End Date:  Nov 2016   Status: Completed

Background:

Primary care faces key challenges: an ageing population with problems of social isolation and loneliness, a growing number of long term conditions and health inequalities. All of these challenges encourage primary care to consider other models which may help people to prevent, manage or treat their conditions. One of these models is social prescribing which is based on linking primary care to the voluntary and community sector via a social prescriber who meets patients, co-produces a sort of health plan and refers patients to voluntary sector accordingly.

In 2014, IHHD was commissioned by the Health Foundation (Shine award) to evaluate social prescribing (SP) in City Hackney. The project was run in collaboration with the Blizard Institute at Queen Mary University of London. The intervention targeted people who are socially isolated and struggling, or suffering from low level mental health problems and Type-2 diabetes.

The SP pathway referred patients from GP practices onto SP Coordinators (SPCs) who would spend up to six sessions with each patient and signpost them to activities in their area (e.g. lunch clubs, volunteering). This SP scheme was one of the most ambitious and innovative in the UK to date:

  1. A large number of GP practices were involved (n=22);
  2. Broad inclusion criteria for referral were set, reflecting the diversity of health conditions people present to their GPs with;
  3. Three SPCs supported 737 participants for up to six sessions to co-produce a well-being plan (Feb 2014 - July 2015);
  4. Participants were signposted to 85 community organisations;
  5. The scheme was rigorously evaluated with the addition of a control group  

A qualitative, outcome, economic and process evaluations were conducted to examine the impact of the intervention. Whilst qualitative evidence showed many benefits of Social Prescribing, quantitative research did not show statistically significant changes in key health outcomes such as well-being, health, anxiety and depression.

Substantial learning emerged from the process evaluation. This showed a wide consensus around the notion of SP with increase GPs’ knowledge about non-clinical support. However, GP referrals need to increase further and feedback loops standardised.

Given that the development of social prescribing interventions and evaluations are in their infancy, there is a need to disseminate knowledge and discuss lessons good (and bad) practice across other pilots nationally. 

Aims:    

The aim of this project was to disseminate and share the learning from the previous evaluation of social prescribing in City and Hackney, scope the building of a centralised forum to pull these disparate learnings together, connecting individuals working in the field so they can share findings, test ideas and discuss best practice.     

Method:    

Partnership Building – collaborate with partners to spread ideas and practice about social prescribing to a national audience.

  • Working with other stakeholders to set up a network.

Sharing information and learning

  • Map stakeholders involved in delivering SP projects across the UK
  • Organise workshops to disseminate work from the previous evaluation of SP in City and Hackney (London) and discuss the strengths and weaknesses of the model and invite contributions from other projects and experts in the field. Themes include:
  1. Case studies of different models of SP identifying their strengths and weaknesses, and practicalities of implementing these (e.g. budget, structure, referral mechanisms, training, outcome measures). It is anticipated that this will attract commissioners and GPs.
  2. The development of a common strategy to inform policy at the national level;
  3. The concept, format and content of the interactive website.
  • The primary audience for these workshops: clinicians and commissioners with an interest in social prescribing; but also patient representatives, community organisation project managers and other stakeholders. 

Impact:    

We help to build a national social prescribing network led by university of Westminster. The National Social Prescribing Network (NSPN) now counts 600 members and has developed into regional events. Specifically, in January, IHHD helped to organise the first conference on social prescribing and facilitated one of the sessions on the evaluation of social prescribing pilots. Following this, the network was asked to provide some guidelines for NHS England which we contributed to as steering group members. In collaboration with NHS England and the NSPN, we then organised an event in Wakefield (7th July 2016) and then sponsored a further event in London (22nd Sep 2016) in collaboration with the NSPN, and Healthy London Partnership (HLP) which was attended by 110 people and considerably oversubscribed (more details below in the workshops section). This event also became an opportunity to discuss draft guidance on social prescribing being led by HLP and NHS London. We contributed to a number of documents and social prescribing in City and Hackney now features as a case study on the learning environment of NHS England case studies https://www.learnenv.england.nhs.uk/pinboard/view/338

  1. We fed our learning into a draft initial document that was used to make the case for the development of SP at national level.
  2. We were involved in separate meetings with staff at the Healthy London Partnership, NHS London and NHS England were we exchanged our learning to be included in the future guidance on SP produced by Healthy London Partnership
  3. Dr Patrick Hutt was invited to shared the learning from social prescribing with Jeremy Hunt though was unable to attend due to the short notice for the meeting
  4. IHHD also advised about social prescribing for the Sustainability and Transformation Plans for North London.
  5. We are Involved in workforce development as part of the Community Education Provider Network. They have been funded to deliver training. IHHD will play a part in this.
  6. We also used findings from dissemination and Shine funding to submit another proposal to the HF around (evidence into practice) around training for SP coordinators and GP practice staff.
  7. Following the conference at the Kings Fund on Integrated Care Patrick Hutt has been able to make a link with Elemental software who are developing software to support social prescribing.
  8. M Bertotti has been advising Redbridge council on their development of social prescribing. He is leading on the evaluation of SP in Waltham Forest, and advising Sutton Council.
  9. M Bertotti has also been developing a bid on the contribution of social prescribing to social isolation to be submitted to the National Institute for Health Research (NIHR).

We have appeared in magazine articles in Pulse Today, which has a wide readership in primary care. See Our work was part of an article and response letter on Pulse Today published on 8th August and end of October respectively. 

We produced a video collecting the voice of users of the service and other key stakeholders: https://youtu.be/PCxRLAM7wBQ
 
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Project Lead:

Dr Marcello Bertotti, Senior Research Fellow
     
Project Team: 
Dr Patrick Hutt, Caroline Frostick
 
Funder:
The Health Foundation (Shine Award)
   
Project Partners:
NHS City and Hackney Clinical Commissioning Group; Royal College of GPs Health Inequalities Standing Group 

For more information, contact: 
Dr Marcello Bertotti, Senior Research Fellow; m.bertotti@uel.ac.uk; Telephone: 020 8223 4139

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