Social prescribing as a way of tackling health inequalities in all health settings

Dr Jagan John, Chair of the North East London Clinical Commissioning Group and Clinical Director for Personalised Care in London.

It’s National Social Prescribing Day – an annual celebration of the community groups and projects that have kept us healthy throughout the pandemic.

Social Prescribing is gaining momentum in the NHS as a way of addressing the wider social determinants of people’s health. This week, the Health and Social Care Secretary Sajid Javid set out his “mission to end the ‘disease of disparity’, which has led to unacceptable health inequalities” for some people in places and communities across the country. He emphasised the importance of personalised care, including social prescribing, in redesigning health services around the needs of individuals, families and communities, so people are more empowered and better supported by a more effective, efficient health service.

Social prescribing link workers, based as part of the multi-disciplinary team in primary care networks, can spend more time with an individual, focusing on what matters to them, and take a holistic approach to their health and wellbeing. This reduces pressures on clinicians and an overstretched NHS, and links people to appropriate support in the diverse community outside of the health service, working alongside the other medical treatments they may be having.

The World Health Organization states that factors such as stress, unemployment, debt, loneliness, lack of education and support in early childhood, insecure housing and discrimination can impact 30-55% of the health outcomes that people experience. We know that one in five GP appointments are about issues wider than health, especially for people living in areas of high deprivation.  Individuals living with multiple long term conditions, disability, frailty or who live in ethnic minority communities are bearing the brunt of the widening gap in health inequalities. This is where social prescribing can demonstrate its value in linking people to community-based services that provide coordinated, integrated, and proactive care.

Social prescribing link workers develop supportive relationships with local and diverse voluntary and community organisations, and other statutory services outside the NHS, like local Job Centres and council education and housing teams. They can then make timely referrals for individuals who may need practical and emotional support from these services, often in ways that are more personal and culturally appropriate.

When COVID-19 started to take hold in early 2020, link workers were deployed to offer support to the most vulnerable patients during the pandemic. Many were supporting primary care networks with their vaccination rollouts, but we also had link workers helping thousands of patients with debt, housing, employment, welfare and mental health issues that had been made worse by COVID-19. In some London boroughs with specific complex needs, specialist social prescribing services for children and young people and refugee and asylum seekers are being commissioned, as too services to support knife crime prevention and obesity prevention.

You may already be familiar with some of the social prescribing success stories. One that resonates for me is an elderly gentleman living in a local residential care setting who was referred to the social prescribing link worker in my practice. He had lots of health issues but was also very lonely. Our link worker picked up there was a piano in his room and after doing some research, she found out he had previously been a concert pianist that toured through Europe. He was connected to some local music groups and is now offering free piano lessons to local families. He is less socially isolated, feels like he is contributing to his local community and is presenting less at my surgery.

While this is a wonderful example of social prescribing in action, it’s also a fairly typical one, so we are working hard to develop specialist workers for children and young people’s services, as well those who can provide social welfare and legal advice in GP practices. This is critical, given the current cost of living crisis and that five London boroughs are in the top 10% of most deprived areas in the country.

Through co-producing our support offer with other London partners including the Healthy London Partnership, London Plus (who champion London’s charities and community groups), the Mayor of London, public health teams and of course NHS integrated care systems, we are embedding link workers in primary care networks, particularly those with different language skills, and are connecting with funding partners to develop “community chests” to build capacity of grassroots organisations. We will also soon launch a social innovation fund for local teams to pilot their innovative ideas for further embedding social prescribing services in their areas.

By next year’s National Social Prescribing Day, we will also supporting people through link workers embedded in mental health trusts, community diagnostic hubs, hospital discharge and A&E teams, as social prescribing can help people in pre and post hospital interventions, those who need to “wait well” for their elective care and individuals who frequently use A&E services because they need help in other areas of their life.

You can follow our progress by checking out our new interactive map of social prescribing services in London for inspiration.  We would also love to hear your experiences of social prescribing too, so please get involved online by tweeting with the hashtag #SocialPrescribingDay.

Dr Jagan John

Dr Jagan John, North East London CCG Chair and Clinical Chair Barking and Dagenham, has worked in the NHS since 1999 and is a GP at the Aurora Medcare Practice in Barking. Before training as a GP, he worked in A&E and cardiology. He has a special interest in cardiology and paediatric cardiology.
Jagan has worked in senior roles in various leadership positions locally and nationally in the NHS, NHS England, and Department of Health and Social Care. He is a strong advocate of personalised health care and excellent patient experience. He is the clinical lead for personalised care in London (NHS England-London) and Healthy London Partnerships. He also works as a GP with a Special Interest (GPwSI) in Cardiology.
Jagan is married with two children and enjoys travelling and spending time with his family. He is a keen West Ham United supporter.