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An Islington GP and the clinical lead for primary care and care closer to home in North Central London STP examines the benefits of integrating care:
In general practice, we’re seeing more and more people come through the system with complex needs caused by the wider determinants of health.
Things such as unemployment, financial difficulties or poor housing conditions. These can represent up to 70% of a patient’s issues and all of which, as a GP, I find it difficult to give support.
However, there is a solution: the voluntary, community and social enterprise sector (VCSE) are well placed to support people with these challenges, and I’m fortunate to work in Islington where we have a really strong and vibrant VCSE sector.
I find that when I refer people into that sector, they really flourish and can have a more proactive role in their own care. This means that I am freed up to focus on a patient’s medical issues; and patients see me less, which helps me to ensure I’m providing care to people who really need it.
This is why, as the clinical lead for primary care, I have been working with the VCSE sector and the five boroughs of North Central London for the past two years. We secured funding to actively bring together a wide variety of people – from the health sector, local authorities, public health and VCSE organisations – to run a series of workshops that helped us connect with communities and co-produce an action plan to help people address their wider health and wellbeing needs.
There were two key outputs:
- A local VCSE organisation did some work to understand how we could support the people who link patients into the VCSE sector to have good conversations. They developed some effective outputs which will be used to create an education and training package.
- To continue building and developing opportunities across North Central London, we set up a social prescribing and self-management support advisory group with representation from CCGs, public health, VCSE leads and clinicians from the five boroughs.
The advisory group has been meeting for about nine months, and we’re beginning to see a step change. We share good practice, filter information coming down at a regional and national level, and it’s helped to raise awareness of how we can work with the VCSE sector to offer their services to our local residents.
Our learning from working together at a North Central London level is also feeding into local areas. We are reducing duplication, coordinating services more effectively, and hopefully preventing people from falling through the cracks that emerge in the system when people work in silos.
In the new GP contract, there is a strong emphasis on the implementation of primary care networks. This is something that we’ve already been working on, so we have the building blocks in place. Commissioning of social prescribing link workers is in each of our CCGs commissioning intentions, and has been recognised as something that each of the boroughs need to prioritise over the next year – an aspiration that is strengthened by the NHS Long Term Plan.
We don’t yet have full coverage of one link worker per primary care network, but because of our existing advisory group we have resources we can share locally so areas are not starting from scratch and can move quickly.
Local Authority colleagues have also agreed to support our plans to deliver social prescribing link workers – so it’s a collaboration not just in health but across local authority too, and we were able to do that because we’ve had this work running for the past couple of years.
The key areas our advisory group is now focusing on include:
- Developing the principles to support a social prescribing link worker service
- Looking at how we can evaluate that service
- Considering the digital resources required to support this approach
- Considering the workforce and educational opportunities that will make this approach sustainable.
By working closely with the voluntary sector we can be absolutely sure we are addressing the needs of our local residents and that we are not asking VCSE organisations to do things they aren’t able to do.
Working together means we can be realistic about what’s achievable and it also helps us to recognise the importance of continuing to effectively fund the VCSE sector so they can rise to the challenges that come their way as a result through this work.
If you are looking to build networks from scratch, there are some key factors that need to be in place:
- Good conversations
- Building relationships
- Ensuring equity of provision
- Having some strong clinical champions
You can access support to start, continue or improve collaboration between health, care and VCSE sector leaders on the Institute for Voluntary Action Research (IVAR) website.