NHS England has worked with key stakeholders to identify the key elements of good social prescribing, which will form the basis of a standard model. These are:
- collaborative commissioning and partnership working
- easy referral from all local agencies
- workforce development
- link worker employed to give time to people
- co-produced personalised plan, based on what matters to the individual
- support for community groups
- common outcomes framework.
No. Until now, most link workers have been part of ‘social prescribing connector schemes’, which have often been run by voluntary sector organisations, providing a single point of contact in a local area and supporting integrated working amongst local agencies. Connector schemes have been locally commissioned by clinical commissioning groups (CCGs) and local authorities. However, they may also be funded by and based in other agencies, such as housing associations, GP federations and NHS trusts, depending on local partnerships.
What is new now is the investment by NHS England and Improvement to embed social prescribing across the whole country. We plan to have at least 1000 additional trained link workers in primary care by the end of 2020/21, with more being recruited after that so that by 2023/24 at least 900,000 people will be able to access social prescribing.
In embedding social prescribing link workers in multi-disciplinary teams, primary care networks have the flexibility to engage link workers themselves, or to work in partnership with existing local social prescribing connector schemes to provide social prescribing services. PCNs can use whatever contractual arrangements work best at local level to facilitate these partnerships. It is important, therefore, that all local partners, including CCGs, local authorities, PCNs, social prescribing schemes and VCSE leaders work together to find the best local arrangements for embedding social prescribing services in PCNs and that, regardless of the engagement model, link workers collaborate in local areas, to overcome isolation, make best use of limited resources and develop strong connections with local communities and partner agencies.
The social prescribing link worker role has emerged over the past few years and has mainly been pioneered by voluntary sector organisations, working in partnership with GP practices and other referral agencies. Link workers are employed in non-clinical roles. They are recruited for their listening skills, empathy and ability to support people.
Social prescribing link workers help to reduce health inequalities by supporting people to unpick complex issues affecting their wellbeing. They enable people to have more control over their lives, develop skills and give their time to others, through involvement in community groups. Link workers visit people in their homes, where needed.
On average, link workers have between 6-12 contacts with a person, depending on their needs, over a three-month period. They connect people to community groups and help the person to develop skills, friendships and resilience. The term ‘social prescribing link worker’ is used generically. However, locally there are many different names used to describe the link worker role. These include community connector, wellbeing advisor, community navigator, health advisor, depending on local preference. Different terms have emerged as local areas have developed their own local schemes.
There are many of these schemes, which we describe as ‘active signposting’ schemes. They generally involve existing staff in general practices, libraries and other agencies providing information to signpost people to community groups and services, using directories and local knowledge. They offer a light touch approach which works best for people who are confident and skilled enough to find their own way to community groups. This complements social prescribing, which supports people who lack the confidence or knowledge to approach other agencies or to get involved in community groups on their own. The personalised support of social prescribing link workers gives people time and confidence to work on the underlying issues which affect their health and wellbeing.
There is a growing body of evidence which shows that social prescribing improves wellbeing for people, giving them more control over their lives. Additionally, evaluations of local social prescribing schemes have reported reduced pressure on NHS services, with reductions in GP consultations, A&E attendances and hospital bed stays for people who have received social prescribing support. In 2017, the University of Westminster published an Evidence Summary, which identified 28% fewer GP consultations and 24% fewer A&E attendances for people receiving social prescribing support.
As part of a wider model of personalised care, NHS England is working with all social prescribing connector schemes to build the evidence base, encouraging all local areas to consistently measure impact. This includes impact on the person receiving support, impact on the health and care system and impact on community groups receiving referrals.
Social prescribing has emerged as a vibrant social movement throughout England and other countries. We estimate that approximately 60% of clinical commissioning group areas in England have social prescribing schemes and this is growing.
In existing social prescribing connector schemes, where there is integrated working, members of multi-disciplinary (MDT) teams can all refer to the link worker, as can social workers, allied health professionals, local authorities, hospital discharge schemes, police and fire services, pharmacies, job centres, housing associations and other VCSE organisations.
Under the reformed GP contract, in PCNs that are setting up new social prescribing schemes, link workers will take referrals only from GPs in their first year of operation. Where PCNs are working with existing connector schemes, referrals can continue to be made more widely.
There is a wide range of digital providers providing apps and creating platforms to support social prescribing referrals. It’s also important to remember that digital tools should complement personalised, and individual, approaches. For many people human support is key, and referral to an online directory alone is not going to work for many of the people we are aiming to support.
No. Up to now most schemes have been commissioned either by local authorities or clinical commissioning groups, with delivery partners mainly in the VCSE sector. Increasingly they are likely to be co-commissioned by partnerships of health and social care working with the voluntary sector, community groups and other statutory agencies.
There is a national group looking at how we could support children and young people through social prescribing, as we believe that many young people access support through schools and colleges rather than through general practice. And across the country, local areas are also looking at how to reach people who may not have a GP, who may be homeless, have problems with substance abuse, or who struggle to connect with primary care.
It’s also worth noting that social prescribing is not a one-size-fits-all national programme. Our approach is to support local areas to nurture innovation and to develop creative approaches.
Social prescribing is not the only approach to addressing the wider determinants of health – or to prevention of ill health. In many areas of the country, integration of health, social care and other local agencies is helping to address some of the broader issues. However, we also have to be pragmatic: many people go to their GP’s because it’s a familiar route to seek help. Social prescribing provides a way to let general practice help people who have more than just a medical need.
Social prescribing relies on trusted local relationships between agencies. Link workers need to know the community groups they are referring people to and help them to manage referrals, so they are not overwhelmed. This can only be effectively done at a local level, which is generally not bigger than a CCG or local authority footprint, depending on how rural the geography is.
It’s difficult to see how one agency could provide social prescribing across a whole STP footprint, because of the need to build trusting local relationships. Where it’s working well across whole STPs, there are a number of ‘local hubs’, working at a manageable scale, but connected and learning from each other.
For social prescribing to work successfully, link workers need suitable support and training. It is also vital that the wider workforce understands social prescribing to enable appropriate referrals. We are developing a training and development programme for the additional link workers coming into primary care, to include online learning, facilitated peer support and regional learning events/webinars. We will publish more details in due course. Link workers in primary care will receive direct line management and supervision from a GP. A sample job description and person specification is included in the Summary Guide to Social Prescribing.
Social prescribing, which is part of the Comprehensive Model of Personalised Care, connects people with a wide range of community-based activities and support. It helps people to improve their health and wellbeing, based on “what matters to me” conversations and a personalised care and support plan developed between the social prescribing link worker and the person they are working with. This could include creative activities such as art, dance, and singing. Or it could be walking football, gardening, fishing, knitting groups. And it might also be to services such as debt counselling, housing and other practical support agencies. It will depend on what that person’s own priorities are.
Social prescribing connector schemes have an important role in supporting the development of community groups, working in close partnership with local infrastructure agencies, where they exist. Link workers have strong knowledge of their local community groups, map community assets, recognise gaps in community provision and find creative ways of encouraging development. They will work alongside the assets and resources that exist in communities as well as with, local commissioners and other partners.