Social prescribing: reducing non-medical GP appointments and delivering a better service for patients – Brownlow Health @ Princes Park Health Centre, North West
Case study summary
Brownlow Health @ Princes Park Health Centre in Liverpool has 3.5 whole time equivalent GPs serving a patient population of over 7,000. When GP appointments for non-medical issues continued to increase, the practice looked at implementing social prescribing by participating in the Learning in Action programme. The programme is delivered by NHS England and NHS Improvement and part of the Time for Care support available through the General Practice Forward View.
Implement social prescribing to help release non-medical GP appointments whilst ensuring patients who require other local/non-clinical services are directed to, or given appropriate support.
Collaborating with other local practices
The practice participated in the programme with 12 other local practices, 9 of which wanted to focus on social prescribing. Over 6 months they attended a series of programme workshops where they exchanged ideas and experiences around social prescribing, updates on their projects and provided constructive peer to peer feedback that would help roll out the project locally.
Having previously implemented social prescribing with limited success, the practice now had dedicated time and the opportunity to use quality improvement tools and techniques, to tackle the outstanding issues. Additionally the collaborative learning environment would provide an opportunity to forge links with other local teams, benefitting the practice as it moved towards becoming a member of a Primary Care Network.
Developing a role for a social prescriber
The practice identified social prescribing as an issue. GPs were raising concerns that they were increasingly seeing patients for non-medical issues such as loneliness and isolation. In such cases GPs were unable to help and rather than accepting they needed to be referred elsewhere, patients would often return for a repeat appointment. This not only prevented patients from getting the support they needed, but also resulted in an avoidable GP appointment.
During a programme workshop the group brainstormed ideas as to how best to implement social prescribing. One of the ideas which appealed to Princes Park was to develop the role for a social prescriber. Returning to the practice they discussed with the GPs what such a role would cover and agreed on the following.
- Deal with all GP referrals where a non-medical issue has been identified.
- Make initial contact with the patient by phone to discuss their issues and invite them in for a face to face appointment with the social prescriber.
- During the appointment assess the patient’s social needs and refer them to other services e.g. coffee mornings, walking groups, Citizen Advice.
- Upload notes to the patient’s record so there is a record of what has been discussed.
- Should any issues arise during the appointment the social prescriber feels the GP should be made aware of, they will inform the GP immediately.
Recognising the value a social prescriber could bring to the practice and the impact it could have on GP appointments, all GPs were fully supportive of the changes being made and agreed to trial it.
The role was filled by one of the practice’s receptionists who had a keen interest in social prescribing and had been participating in the Learning in Action programme. She was given four hours of protected time every week where she could fully focus on the work. The impact of the role would be reviewed regularly to see how successful it was, this would be done by the social prescriber attending manager meetings to give updates on the project and discuss any issues/feedback.
Demonstrating early successes
The impact of the role quickly started to emerge – patients that GPs referred were either dealt with in-practice or referred to another service that would better support their needs. Positive impact stories are as follows.
- A patient who regularly saw their GP for depression and anxiety issues has only visited the practice twice, both times to see the social prescriber rather than a GP. With the social prescriber’s help they have taken up photography and guitar lessons, which has helped tackle their anger and stress issues.
- A patient in her early sixties who was regularly seeing a GP because she was always feeling low has joined a walking and lunch club and no longer needs to see her GP. Her confidence has grown and she is now looking for employment.
Loneliness and low physical activity were common themes identified by the social prescriber. To help these patients the practice started a weekly walk in the park club, which has an average monthly attendance of 24. Previously these attendances would have resulted in a GP appointment.
Due to the success of the trial the practice is now looking to make the role permanent.
From receptionist to social prescriber
The practice recognises that the success of the project has very much been down to the social prescriber who has embraced the role and developed the skills to effectively work with patients.
Through the programme and with the support of the practice, her confidence has grown hugely helping her to take on the following.
- Attend regular practice team meetings to share updates and successes of the project with GPs and the wider practice team, as well as areas for development.
- Presenting at programme workshops to share learning and experience with other local practices so they do not have to start from scratch to tackle the same issues.Furthermore, she now has knowledge and application of quality improvement tools and techniques that will help her continue to make changes in the future.
- Over 4 months the social prescriber has seen 40 patients. Looking at the attendance of just 3 of these patients between May 2018 and February 2019 (10 months) the practice found that collectively they had seen a GP on 20 occasions for a total of 600 minutes. Since first visiting the social prescriber in March 2019 (3 months) this has reduced to 1 visit by 1 of the patients.
- GPs have been able to redirect the time released to those patients who have medical issues. GPs are extremely happy with the outcomes. Their appointments are being used more effectively and they are seeing more patients they can help.
- The role of the social prescriber has developed the practice team and provided an additional service that was previously unavailable. Demand for appointments with the social prescriber is increasing.
- Patients are benefiting from a better service, their needs are being dealt with more effectively and they are accessing the support that is addressing their needs.
- Establishing links, sharing learning and experiences with other local teams, has put the practice in a good position to embrace new ways of working as part of a Primary Care Network.
“Since seeing Michelle I am occupied, relaxed and my mind is content which helps with my depression.” Keith Johnson
“It’s got me out of the house meeting people.” Michael Duggau
“It’s been so beneficial for patients and the GPs have been really supportive, if it wasn’t for this programme we wouldn’t be where we are now.” Michelle Roach, Social Prescriber, Brownlow Health @ Princes Park Health Centre
“Michelle’s work focuses giving people a quality of life and a sense of wellbeing and hope. I have seen huge improvements in one particular patient, who has a long history of mental health problems and isolation. She is now hoping to engage in courses and community activities and is clearly taking better care of herself.” Laura Stirratt, GP,Brownlow Health @ Princes Park
“So often I am aware that the problems of the person sitting in front of me are not something medicine can treat and it is fantastic to now be able to offer them something that would really help – the opportunity to speak to the social prescriber and work out what they need.”Kate Mckinnell, GP, Brownlow Health @ Princes Park
If you would like to find out more about participating in the Learning in Action programme, along with details on how to apply, visit our web page.