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GPs buried under trusts' workload dump

Social prescribing scheme ‘did not cut GP workload or improve patients’ health’

Referring patients for social activities such as gardening or cooking did not cut subsequent GP consultations or improve patients’ health outcomes, an evaluation of a pilot scheme at East London practices has found.

The GP academics who lead the study found that the patients referred to 'link workers' in the practice - who refers them to programmes involving gardening or cooking, for example - continued to have higher GP consultation rates and to use more prescription medicine a year after referral than the control group.

However, they also said more research was needed to fully evaluate the approach, and that the scheme may have had wider societal benefits that they were unable to capture.

It comes as the Government is looking to increase the amount of social prescribing available for patients.

The study looked at a social prescribing scheme that is ongoing at 22 of the 43 GP practices in City and Hackney CCG, aimed at cutting down on GP consultations and improving the health of isolated over-50s and people with type 2 diabetes.

Under the model, GPs and other practice staff direct referrals to a ‘link worker’ based in the practice, who then puts together a care plan with the patient and refers them on to one or more local services that offer programmes for activities such as gardening, cooking, art and mother and toddler groups.

The researchers analysed data on health care use, attendance at the GP practice and prescriptions for 381 patients referred into the service, compared with those for control patients with similar backgrounds and comorbidities.

The referred patients had much higher consultation rates both before and one year after referral than did the control patients – more than eight a year on average, compared with four a year among controls.

They also used more prescription medications both before and after referral.

And the referrals showed no change in general health, wellbeing, anxiety, depression or self-management – measured by standardised questionnaires – at eight months of follow-up.

Lead author Dr Sally Hull, a practicising GP and reader in primary care development at the Queen Mary University London, told Pulse ‘there was no demonstrable impact on GP consultation rates’ and that ‘we were not able to show a change in outcomes such as levels of depression, anxiety or confidence in self-management’.

However, she noted that the team only had full outcomes follow-up data for a small proportion – 14% – of patients, and that a proper randomised controlled trial would ideally be needed to test out the approach properly.

Dr Hull said: ‘I think we remain uncertain of the cost effectiveness of social prescribing to improve individual psychosocial health or to reduce the burden of attendance at GP surgeries.

‘That does not mean we should stop the schemes. Rather we need better ways of evaluating them. I believe that we should look for outcome measures related to markers of social capital, rather than the somewhat narrow measures of attendance at surgery.’

The drive towards social prescribing 

Social prescribing was hailed as an important route to managing patient demand in NHS England's GP Forward View and a recent King's Fund report said GPs should prescribe 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 over role they 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.

Readers' comments (12)

  • "Anonymous | GP Partner09 Aug 2016 1:31pm
    Completely agree with Practice Manager 8:46am probably one of the most sensible comments on Pulse ever. "

    And yet, Pulse moderator deleted it entirely. People are far too touchy nowadays.

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  • Writing here as Clinical Lead for project here in City and Hackney.

    I think one of the main challenges for social prescribing is trying to capture the impact it has. The city and hackney pilot had quite broad aims. While the quantitative data showed no difference in the survey outcomes (it had quite a low response rate at follow up) there were some very strong qualitative data findings, where patients describe 'life changing' outcomes. As one participant described: ‘ It’s done me a world of good, taken me out of the house, given me a routine and given me a sense of purpose and… hope. It’s given me back my confidence.’

    I would encourage people to read the Shine Innovation Report – which can be found here:
    www.health.org.uk/sites/health/files/City%20and%20Hackney%20CCG%20final%20report.pdf

    Social Prescribing is in its infancy. If it is going to succeed we need to ensure that the services develop alongside the evidence base. Hopefully initiative like the social prescribing network can foster this learning.


    Dr. Patrick Hutt
    City and Hackney CCG Clinical Lead
    Social Prescribing Service

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