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GPs buried under trusts' workload dump

GP social prescribing drive 'unacceptable' given lack of evidence, warn researchers

The Government’s drive to get GP practices to refer patients for help with social problems like housing and loneliness is not supported by research evidence and is an ‘unacceptable’ use of precious NHS resources, health policy experts have warned.

Researchers said their systematic review of such schemes showed the evidence base was ‘a mess’, with biased reports being used to promote the agenda on social prescribing.

Social prescribing programmes involve a range of models whereby GPs can refer patients – usually to a linkworker employed by the practice or a local group of practices – for help with non-medical problems, such as chronic loneliness or finance and housing issues.

Several CCGs across England are rolling out such programmes with encouragement from NHS England, which promoted the programmes in the GP Forward View after they received the backing of health secretary Jeremy Hunt. NICE has also endorsed the approach, calling for GPs to refer vulnerable people to singing, dancing and art classes.

The systematic review, carried out by researchers based in York, Leeds and Manchester, and published in BMJ Open, looked at UK studies of such programmes that were published between 2009 and 2016.

The investigators identified 15 eligible studies in which patients were referred to a range of interventions such as exercise, housing and welfare advice, adult education, befriending, counselling, self-help groups, luncheon clubs and art activities.

They found none of the studies could be trusted because they were highly likely to be biased from the outset, while most were small scale and poorly designed and reported.

Yet, ‘despite clear methodological shortcomings, most evaluations presented positive conclusions’, the authors wrote.

They concluded: ‘Social prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money.

’If social prescribing is to realise its potential, future evaluations must be comparative by design and nconsider when, by whom, for whom, how well and at what cost.’

Co-author Paul Wilson, a senior research fellow at the University of Manchester, told Pulse: ‘The reality of the evidence base for social prescribing is it is a mess. As such, we are not yet able to reliably judge which, if any, social prescribing programmes are worth pursuing further and or what the added value may be to existing services.’

He added that ‘in the current financially constrained climate this is unacceptable’.

‘New ideas and ways of working are not without cost or consequences. They compete with existing services for finite resources,’ Dr Wilson said.

It comes as NHS England’s appointed lead on social prescribing has called for every practice to be given £1 per patient to fund such schemes, and Pulse has revealed that several CCGs are already investing heavily in the programmes, although large-scale evaluations are yet to report their outcomes.

NHS England was approached for comment but had not responded at the time of publication.

The drive towards social prescribing

Social prescribing was hailed as an important route to managing patient demand in NHS England’s GP Forward View . The King’s Fund has advocated the benefits of GPs prescribing gardening to patients with conditions such as heart disease and dementia.

However it remains uncertain how effective social interventions are – and GPs have conflicting opinions about the role they should have in general practice, with some arguing it provides GPs with alternatives to traditional care to help manage patients and others branding it ‘a waste of time’.

Dr Arvind Madan, NHS England’s director of primary care, has said that the ‘ambition is that, eventually, every practice will have access to all the initiatives in the GPFV’, including social prescribing options.

Pulse revealed last year that NHS chiefs were pushing for every GP practice to have £1 per patient for social prescribing, and Pulse has revealed that several CCGs and local councils are now investing heavily in the schemes.

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Readers' comments (4)

  • The great thing about social prescribing here in Gloucestershire is that the receptionists can identify and refer the patients, without them coming to me. Or if they ask me for a housing later I can just bat them straight to the social prescriber.

    These people are reducing my workload, and although the evidence base may not be there, I really strongly think we should be increasing the evidence base, not throwing out the baby with the bathwater.

    There is precious little else that genuinely reduces the rubbish I have to wade through on a daily basis - social prescribing is a huge benefit to let me get on with the medical side of it, and actually feel I can pass them on to someone who can help them with the social side of things.

    Absence of evidence is not the same as evidence of absence.

    Get working on creating a decent evidence base before dissing this one!

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  • Social Signposting needs qualitative research to evaluate it. How can you quantify non-numerical outcomes? And the value of Social Signposting is not in how much money or GP time it saves (as it likely doesn't, significantly), but in the integration of non-medical, social and community supports to enhance opportunities and wellbeing

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  • we all know this left wing rubbish will only encourage patients, keep them away from our surgeries - what we need is a £5 charge per patient - I could then work half time with my feet up.... bliss

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  • These people shouldn't be coming near our Practices, and using our receptionists time, and frustratingly my time.
    Why are we reinventing the wheel with this? Citizens Advice Bureaux have existed for decades. Just give them the support, advertising and funding they need.
    Keep these people away from my Practice!

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