Michael Dixon, Chair, College of Medicine

Published in JHH15.3 – Social Prescribing

Ten years into general practice, I was burnt out. Swamped by patients presenting with a range of problems from chronic tiredness, frequent minor infections, irritable bowel, headaches and back pain to stress, loneliness and sheer misery. Discovering complementary medicine gave me back my professional life and radically altered my views on how to heal and the importance of balancing the perspective of clinician and patient.The College of Medicine advocates an open-minded approach to health and healing that includes complementary medicine and other non-biomedical interventions such as the arts and healthy eating, which are being increasingly offered under the umbrella of ‘social prescription’, which is another college-led initiative.

It became very clear that patient groups, GPs, CCGs and local authorities were looking outside the biomedical box Click To Tweet

Social prescription has become a social movement whose ultimate aim is to create communities that make us healthy rather than ill. Its astonishing progress has been due in part to the altruism and passion of those who have been developing programmes throughout the UK. But it is also due to a growing recognition within the biomedical world that our current medical model is unable to solve the exponential increase in obesity, diabetes, stress, depression and even cancer. Social prescription represents ‘the other way’. Our second national conference on social prescription on 6 November is titled Social Prescription – Coming of Age. For the cause of holistic medicine and all that this journal represents, it is a final and irreversible ‘coming up for air’.

As a national and international movement, social prescription was born three years ago somewhere around Reading on a train journey from Devon to Paddington. At our GP centre in Devon, Marie Polley, now co-chair of the National Social Prescribing Network, had just finished researching the effects of providing a social prescription to patients who were diabetic or at risk of diabetes. After nine months a third of them had converted to no longer being either diabetic or at risk of diabetes. ‘What next?’ we asked ourselves.

We had been working alongside the Bromley by Bow Centre in Tower Hamlets, London, over several years to develop and provide social prescription but funding had always been difficult and frequently had to be sought through private sponsors. It was time to make the world – patients, professionals and media – aware of social prescription and to get it universally recognised and funded.

Our first step was to bring together all those that we already knew were pushing the boundaries. We turned to innovators like Professor Chris Drinkwater in Newcastle West; Dr James Fleming and his Green Dreams project in Burnley; the work under way in centres at City and East London in Rotherham; Gloucestershire and of course Bromley by Bow. We formed a self[1]elected leadership group of around 12 clinicians and academics. Our next step was to invite anyone who might be interested or involved in social prescription to a meeting in London in January 2016. Having secured a Wellcome Trust seed award and support for a meeting from AbbvVie, we speedily arranged a conference in central London, expecting at most around 30 or 40 people to come.

In spite of minimum publicity 150 people applied but we had to limit it to 100 because of space. It is a pattern that has repeated itself over the past two years with every conference or meeting on social prescription being oversubscribed many months in advance. It became very clear before, during and after that first meeting (of what was to become a nascent National Social Prescribing Network) that all over the country patient groups, clinicians (especially GPs), clinical commissioning groups and local authorities were looking outside the biomedical box when it came to both care and improving the health of their local population.

These initiatives had one thing in common – they were linking people to local voluntary and community groups. The initiatives varied from fishing clubs, knit-and-natter groups, singing, dancing, reading and theatre groups to green exercise, gardening clubs and yoga/Tai Chi. Remarkable projects with remarkable results came pouring out of the woodwork. Clearly an enormous wealth of pent-up energy had been working below the radar and was about to explode on to the national stage. By the time of our House of Commons launch two months later the national network had grown to 300 strong, and it has grown to well over 2,000 today.

At our House of Commons launch in March 2016, Dr Sarah Wollaston, Chair of the Health Select Committeec was due to chair. Family illness kept her away so Stephen Dorrell (the previous Secretary of State for Health and current Chair of the NHS Confederation), affirming his own commitment to social prescription, stepped in. Janet Wheatley, from Rotherham CCG, launched an ongoing debate when she said simply ‘it’s just common sense’. Her view represents those who find it obvious that social prescription and non-medical interventions can improve health using available volunteer and voluntary resources. At the other extreme, a more traditional NHS lobby keeps potentially effective interventions at bay for decades pending double blind placebo-controlled evidence.

Something extraordinary happened at the launch. A remarkable dialogue and relationship between the College of Medicine and the University of Westminster had started the ball rolling for social prescription. There had been some discussion already with NHS England as to whether it would take an interest in social prescription. All too often Whitehall takes a good idea from the front line, magnifies and mistranslates it and then drops it on already overstretched clinicians and organisations. But this time NHS England was both courageous and correct in deciding to join to work hand in glove with the front line to enable social prescription to develop a united vision together with the National Social Prescribing Network, the College of Medicine and University of Westminster. To maximise knowledge, commitment and passion I was appointed national clinical lead for social prescription and the University of Westminster was commissioned to research the current state of play and the economic implications of social prescribing (Polley, Bertotti et al, 2017; Polley Bertotti et al, 2017).

There is hardly a single social prescribing project that could be said to be financially sustainable

Today we are defining social prescription as involving a prescriber, a link worker and a menu of activities and interventions the link worker can offer. And we now have a commitment to roll out social prescription from Simon Stevens, chief executive at NHS England, who said in the national press that he would like every GP to be able to offer it; the Mayor of London has incorporated social prescription in his health strategy; it is now being offered in a number of clinical commissioning groups and in South Yorkshire’s Sustainability and Transformation Plan. Some form of social prescribing is going on in almost half of clinical commissioning groups, where the normal model is co-funding between the local clinical commissioning group and local authority.

There are two main challenges ahead. The first is how we create a sustainable funding model that makes social prescription an intrinsic part of the NHS and its funding flows. This is especially needed to enable voluntary and community groups to plan sustainable provision of initiatives. At present there is hardly a single social prescribing project that could be said to be financially sustainable beyond two or three years. The second challenge will be to keep social prescription faithful to the principles of those who have pioneered it and to avoid it being dumbed down to mere signposting, or a one-size-fits-all process. Research on how and where it works best will also help to determine its future direction.

Meanwhile, much needs to be done. NHS England with its regional networks, mapping initiative, creation of a common framework for data collection and other support will be leading the implementation of social prescription in England. Its close connection to those who have led the process to date and those who are currently leading social prescription at the front line should ensure that the process of universalisation proceeds without hitting the rocks. Meanwhile, there is a pressing need for independent research to guide the progress of social prescription. Following a booked out international conference on social prescribing research at the University of Salford this summer, the National Social Prescribing Network is evolving as leader and co-ordinator of such future research. There is also increasing interest among the other three UK nations, with Scotland in particular advancing social prescription rapidly. Health and social care partnerships have submitted primary care improvement plans to recruit and allocate 250 link workers, to support Scotland’s most deprived communities and tackle inequalities. In early 2018 Wales formed an all-Wales social prescribing research network and Ireland and Northern Ireland are collaborating with their own Social Prescribing Network Ireland. With increasing invitations to speak abroad, the College of Medicine, University of Westminster and National Social Prescribing Network are at the head of an emerging international movement, led by the UK, whose first international conference will be held in London in June 2019. Great Britain with its unique National Health Service, free at the point of delivery, is the ideal seedbed for an idea whose time has certainly come.

References

• Polley MJ, Bertotti M, Kimberlee R, Pilkington K and Refsum C (2017) Review of the evidence assessing the impact of social prescribing on healthcare demand and cost implications. London: University of Westminster.
• Polley MJ, Fleming J, Anfilogoff T and Carpenter A (2017) Making sense of social prescribing. London: University of Westminster.