NHS Long Term Plan and Social Prescribing

Social prescribing is a form of community referral. It is the prescription or provision of non-clinical activities to help improve a person’s health and wellbeing, within their local community for ease and comfort. The idea behind this holistic approach is to build a foundation of support to keep a person engaged with their own wellbeing.  

The first recorded instance of social prescribing in action in the UK was in 1984, and since then more and more NHS Trusts have engaged with the concept and it is now an official target within the NHS Long Term Plan. This is a 10-year plan to ensure the UK’s national health service continues to improve; meeting the needs of the people and technological advances as it does so.  

Designed by experts across the care continuum and throughout the NHS, the Long Term Plan has three clear goals for delivering world-class healthcare and support: 

1. Enabling everyone to get the best start in life
2. Helping communities to live well
3. Helping people to age well

These goals will be delivered by social prescribing link workers; trained staff engaging at a more personal level than GPs, nurses, or other clinicians.

The NHS wants to encourage joined-up care, and to build a nationwide ecosystem of data sharing so that patients can be given the same high quality care regardless of where they are in the UK. The NHS 10-Year Plan is advocating for many of the changes needed to achieve such a system, and one of the policies it is now targeting is social prescribing.  

There are seven areas where social prescribing is used within the NHS: 

1. Integrated Care Systems (ICS)
2. Social Deprivation
3. Primary Care
4. Community Care
5. Mental Health
6. Public Health
7. Social Care 

The aim is to use social prescribing to unite these aspects, allowing the NHS to provide more diverse support to people. This will be achieved through the NHS Personalised Care Model and Primary Care Networks, which are supporting community programs and services.

Primary Care Networks (PCNs) are collaborative NHS groups. They work between teams to provide the community care; linking GP practices and local healthcare services to coordinate decision making and patient tracking. The Social Prescribing Link Workers tasked with engaging people outside of a clinical setting report to their local PCN.  

Since 2019, every PCN with a population of 30,000 people or more is able to employ a full-time Link Worker, while populations over 100,000 can hire additional staff. NHS England is covering the costs of these hires. This is done through the Additional Roles Reimbursement Scheme (ARRS). 

As of late 2020, the NHS reported more than 1,200 social prescribing link workers were employed, though we know from Steve Barclay MP (former Secretary of State for Health and Social Care) that this figure is now over 3,000 according to what he told the media at the Social Prescribing Show earlier this year.  

What is the NHS Personalised Care Model?  

The NHS England website details the comprehensive model of personalised care, but the simple answer is that this is a six-point strategy designed to engage individuals with their own care and wellbeing. It wants shared decision making between patients and clinicians, as well as greater patient choice, community support via social prescribing, and supported self-management. 

To achieve all of the above, the NHS Long Term Plan has key targets: 

• Deployment of the NHS Personalised Care model across England, with an initial target of reaching 2.5 million people by 2023/24 and 5 million people by the end of the 10-year plan. 
• By 2023/24, every GP surgery in England will have access to at least one social prescribing link worker. 
• 1,000 or more trained social prescribing link workers in place by the end of 2020/21, with the added aims of increasing these numbers going forward (amount unspecified) to help hit a target of 900,000 referred to social prescribing schemes.
• Rollout of Personal Health Budgets, with an estimated 200,000 people benefiting from a PHB by 2023/24. These budgets account for the provision of things like bespoke wheelchairs, but also community support, mental health services, and social care. 

The good news is that the social prescribing link workers have hit the ground running. Christiana Melam, Chief Executive of the National Association of Link Workers, issued a statement on the NALW website saying: “Social prescribing link workers are flexible generalists who specialise in social prescribing and they met NHS Long Term Plan target 2 years early; NHS England should consider further expansion in the following review.

Social prescribing fits into the joined-up care ambitions of the NHS. There is a greater need to connect people and services to help improve quality of life and reduce health inequalities​. Frontline services are stretched both in terms of demand and funding, but what’s stopping social prescribing from meeting the NHS Long Term Plan’s targets? 

Data: The NHS Long Term Plan website confirms that NHS England will provide a bigger share of funding towards areas with greater health inequalities. This is a Catch-22 situation however; Trusts don’t want to act without statistics, but to get evidence they need to act and introduce engaging opportunities like social prescribing. 

Without statistical evidence, investment into services cannot be justified, which means communities lose the support they need from their Trust. This disconnect can be hugely damaging, and it has a knock-on effect disengaging the local population and their NHS Trust – be it a GP, nurse, or other clinician.  

PCNs: National Voices reported back in September 2020 about how PCNs were fitting in to the existing NHS structure, and the concerns that the VCSE sector had. These voluntary or charity groups operate on modest budgets and were struggling to determine where there focus should be: on working with PCNs or with the local Integrated Care System (ICS). This is especially problematic as the initial promise in 2019’s Long Term Plan was for five years of funding, not 10. 

Literacy: The UK government’s social prescribing webpage points to statistics from the Institute of Health Equity, published in 2015, which showed “up to 61% of the working age population in England finds it difficult to understand health and wellbeing information.” This is hindering the reduction in health inequality. 

It is also compounded by digital literacy issues too, with many people – especially the elderly – unable to utilise social prescribing opportunities that aren’t in-person due to a lack of confidence or capability with technology. In a modern age of face-time phone calls and instant messaging, this can be particularly isolating – encouraging further loneliness. 

Support: Research on health inequalities from the NHS Long Term Plan team showed that young carers in particular feel isolated, distressed, and in some cases invisible. Up to 40% of those surveyed reported mental health problems as a result of their care duties – a threat that risks losing vital support towards social prescribing goals and the needs of patients. 

For more information you can read Claire Wardle’s article on health inequalities and how to reduce them. 

Institutional Change: The National Library of Medicine delivers what is perhaps the biggest challenge for the NHS to overcome. It argues that the shift towards more preventative care in the community care will take time because the approach is being driven by personalised, individual care, and this risks being at the expense of interdependence and community-driven care needs.

Social prescribing is a preventative measure, designed to mitigate minor ailments and reduce the impact of long-term conditions on daily life. It can help people in pre or post-hospital scenarios. By engaging with people in their community and in their personal life, people can be onboarded or included in their own care action. They have agency and impact, and can see the results of their actions. These results can be the encouragement and stimulation to keep them engaged with their own wellbeing going forward into the future. 

The King’s Fund published an article in 2017 (updated in 2020) on social prescribing. They cited reports from Bristol and the University of West England (UWE) in the early 2010s in which they found reductions in anxiety levels, in suicide risk, and in the costs associated with mental health care around these factors. Similar schemes in Rotherham showed a reduction in inappropriate A&E usage, better quality of life in Bradford, and greater patient engagement and reduced loneliness in Shropshire – as per a report from The Social Prescribing Unit at the University of Westminster in conjunction with Help2Change Shropshire. 

Importantly, feedback given by service users was positive. People liked the availability of social prescribing link workers, the engagement, the elements of choice for time of appointment or location, and the fact they were able to build up a rapport and feel listened to. One user said: “How often do you get offered an hour’s chat about a particular problem in a doctor’s medical centre?  You don't and I do have to say that was really quite an incentive.” 

We published a case study on Merton Connected, one of our partners. Merton Connected found 70% of patients felt happier after using social prescribing, and 67% patients found their anxiety reduced following social prescribing.

These examples are evidence that social prescribing takes the burden away from GPs. By subtracting inappropriate cases from their patient load, doctors can accommodate more appointments. This in turn relieves the burden on A&E usage. It also has a knock-on effect by freeing bed space, which alleviates the issue of ambulances queueing in hospital car parks waiting to deliver their patients and thus being unavailable for further emergency callouts. Social prescribing, in time, can help stop all of this. No more treatment in the car parks, and no more patients having to sleep on beds in corridors rather than on wards specifically. 

Social prescribing can do more for people though. By generating crucial demographic data, it can help the NHS – and specific Trusts – better accommodate the needs of their local communities and the population. This works inversely too, in that the engagement with the public also allows the measurement of the uptake of key population health management strategies and other health commitments. Better community engagement provides the data, which in turn means there’s evidence to make more appropriate decisions. The better the intelligence, the more impactful the decision making, the more effective the care, and the more value for money the Trust gets.

Social prescribing is popular because of the benefits it offers to the NHS, specifically regards alleviating pressure on GP surgeries. The UK – and England in particular - has a shortage of GPs, and general practitioners are seeing more patients per person than ever before.  

Statistically speaking, almost 20% of consultation time is used on non-clinical issues. Additionally, it’s estimated that the cost of this improper care to the NHS is £400 million. This isn’t to say these problems should be dismissed or disregarded, but there are ways to address and investigate these issues without using the time of GPs or at such expense.  

The NHS Long Term Plan is all about digitisation and enhancing current service delivery. Social prescribing is no different. Trusts need software solutions, because people power is costly and inefficient. Stakeholders need to be researching and planning: 

• What’s going well with our social prescribing? 
• What’s not so good? 
• How many people are we helping? 
• How many people want our help? 
• Are enough people aware of the social support available? 
• Are we working closely enough with primary care? 

A full and frank assessment of your own performance will allow you to highlight areas of improvement, and this will then allow you to be choose the most appropriate social prescribing software to suit your needs.

Using people over automated software is slower and less accurate, but not only that it’s taxing on the staff too. Many of these jobs are repetitive, which leads to a loss of focus. That’s not unprofessional or neglectful, it’s just human nature. People need variety and engagement, and there’s plenty of that available working within the NHS and in the field of social prescribing. 

Access Elemental social prescribing software is designed for GPs and other frontline healthcare professionals. It allows clinicians to refer people to a Social Prescribing Link Worker, a Care Coordinator, or a Health Coach. In doing so, it is empowering individuals to resolve problems or meet their needs in a community setting through local programs. 

What can Elemental do? 

• Data: We can help your Trust/ICB measure the uptake of population health management objectives or public health commitments. This data can also be analysed to identify areas of social deprivation and health inequality, which is the evidence needed for new objectives, hiring more healthcare professionals, or adjusting local care strategies. 
• Patient Notes: Elemental can track attendances and patient progress via integrating with other case management systems, allowing for more tailored decisions. 
• Proactive Care: Early interventions and interim referrals to slow deterioration of a person’s condition. 
• Preventative Care: Support those exiting care settings to avoid relapses and reduce readmissions. 
• Security: All referrals are captured and tracked in Access Elemental. We ensure that only pre-approved services are available for clinicians to utilise, which in turn gives them peace of mind and reduces patient risk regarding handover to new services and support staff. 
• Interoperability: Access adheres to HL7 FHIR standard APIs to ensure compatibility between our solutions and other software. Access Elemental specifically can send specific SNOMED codes and encrypted data/text to automatically update patient information between systems, saving the referrer time. 

Our Elemental software is a cloud-based platform designed to fully integrate with primary care, secondary care, and social care systems. It protects data from outside attacks, as well as internally through the use of permission-based security. This means that only approved personnel can access certain sensitive personal medical information. 

We want healthcare professionals to be able to trust a solution and see the benefits that social prescribing can have. Social deprivation occurs in communities, so it only makes sense to begin proactive and preventative care within these same communities. With a trusted solution in place like Access Elemental, you can track patients, record data, and maintain connections between link workers, GPs, and other care providers: a healthcare ecosystem providing joined-up care.

This brings us to an end of our article on social prescribing and how it can fit into the NHS Long Term Plan. We hope you have found this piece insightful and can see why the benefits of social prescribing are worth overcoming the challenges of pursuing such care. 

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