Tim Anfilogoff is Head of Community Resilience at Herts Valleys CCG, and NHS England’s Social Prescribing Regional Facilitator for the East of England. Here he looks at the crucial role of social prescribing in responding to COVID-19 and the lessons learnt for the future.
“It’s been an incredible year”, says Gina, a social prescribing link worker in Hertfordshire. “I’m lucky to belong to an extended team who made hundreds of shielding calls, followed up patients needing support and received referrals from surgeries too: 230 this year which is amazing!”
In the words of the Royal College of General Practitioners (General Practice in a Post-COVID World, 2020): ‘The social prescribing link worker role has really come into its own in the pandemic response. Social prescribers have often been at the heart of local support for vulnerable patients. This is a practical demonstration of the role that primary care can play in building community resilience and tackling health inequalities.’
With over 1,300 social prescribing link workers now in post in the NHS across England, many inducted during a global pandemic, it is a good time to take stock of how this crucial role is being used and how it should develop.
Not least because, while Gina and many others have found these jobs incredibly rewarding, there is a risk of link workers feeling isolated. It is vital that they are integrated with practice and Primary Care Network (PCN) teams.
The necessity for remote working because of the pandemic has taught individual link workers and practices a lot about the surprises you can get when ringing people to see how they are. Often people would not have proactively sought help, so you can head off all sorts of problems.
Working this way adds a preventative element not achievable just through a referral-based model – exactly what we should be aiming for in improving population health.
But at the same time, suddenly being confronted by clients expressing suicidal thoughts or disclosing domestic abuse requires resilience, skill and access to excellent support and supervision from the wider primary and community care team.
Working with communities
Flexibility has been key in how the NHS has responded to the pandemic – not just in caring for people with COVID-19, but also keeping other services running. Link workers have, in urgent situations, had to deliver food parcels or oximetry kits or help with vaccination clinics, rather than arranging for other voluntary organisations to do this. But this should not be seen as a sustainable way of using them.
We need a healthy and adequately resourced voluntary sector going forward. This will be a challenge as we all know, but it is that which will allow social prescribers to focus on their key role: harnessing the transformative power of holistic social prescribing, based on ‘what matters to me, not what is the matter with me’, including spending the time needed to get the right results for people with complex needs.
Population health and health inequalities
The recent inclusion of more people on the lists of those who are clinically extremely vulnerable (CEV) has been one demonstration of the impact of social determinants on health.
And this has given us an opportunity to proactively engage with people who may be most likely to benefit from social prescribing.
Link workers should continue to help PCNs reach out to people and communities for whom their social situation often adds huge challenges to leading a healthy life, as part of the drive to tackle health inequalities and improve population health.
They can help support people to come forward for care when they need it, identify carers who may not have had a break for a year, reach out to those bereaved during COVID or help people access back-to-work support; all of which can make a real difference for people who would otherwise be at risk of depression and anxiety.
We need to work together to identify and work through the best way to do this, but it must be part of the future.
Recovery needs link workers
The last year has very clearly demonstrated the need for and value of social prescribing, both to individuals and to the NHS.
As we look ahead to what the NHS needs to do over the next six to 12 months and beyond, I think it is pretty clear that we need to recruit more social prescribing link workers, but we also need to remember that we cannot expect one link worker to do all of the above on their own.
The money for creating new roles is available to all PCNs through the Additional Roles Reimbursement Scheme, and the link workers have shown themselves both a very flexible resource and very good value for money.
The NHS Operational Planning Guidance for 2021/22 addresses the issues of recovery from the pandemic, and its impact on widening health inequalities. It includes the requirement to deliver the NHS Comprehensive Model for Personalised Care, which gives people more control over their own health and will under pin systems’ efforts to recover services and address health inequalities.
Social prescribing is a key element of personalised care, and of the NHS Long Term Plan. Social prescribing link workers are part of the primary care network contract, which aims to provide a social prescribing service across the whole country.
Social prescribing is a way for local agencies to refer people to a link worker. Link workers give people time, focusing on ‘what matters to me’ and taking a holistic approach to people’s health and wellbeing. They connect people to community groups and statutory services for practical and emotional support.