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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)

  • The government is twisting and turning to try and find some way of reducing the cost of health and social care. However this scheme is just like adding another lane to the motorway. Patients still want the same number of GP consultations, but will also want/demand the ongoing follow-up from social workers, OT and support groups. So it is just increasing the overall cost even further. Both Admission avoidance and Telehealth schemes have been equally unsuccessful in reducing admissions. Sadly copayment and limiting the number of consultations will be the only way to limit the cost of health and social care. Of course it is politically very difficult to bring in, but the day will come.

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  • For goodness sake.....it's been evaluated as failing..so throw more money t it and find a different way of evaluating until they get the result they want. Come on Sir Sam Etherington you were lead in setting this nonsense up even you must admit failure sometimes

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  • In South Warwickshire we found it reduced GP consultations by 20% and also reduced unplanned admissions and A&E attendances. Look at the 75+ model by primegp.co.uk . Now recommissioned and being copied.

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  • Bob Hodges

    It works in Gloucestershire, and we have similar numbers of patients.

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  • Where it worked did you compare similar cohorts with and without being offered this intervention? There is a significant reversion to mean effect in most high users of healthcare from year to year.

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  • This comment has been removed by the moderator.

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  • how surprising.
    insane scheme set up by the terminally naïve
    what a waste of precious nhs money!

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  • WTF has this got to do with being a doctor? Completely agree with Practice Manager 8:46am probably one of the most sensible comments on Pulse ever. Surely this is the remit of social workers/public health?

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  • Until we start charging patients for consultations this inappropriate demand will continue.Patients are not dying in the streets of Dublin or Dortmund simply because they have to pay a few euros to see a doctor.
    A blunt instrument perhaps, but squandering scarce funds on tree hugging cannot be justified.

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  • To Simon Gilbert- yes we did compare cohorts. Pts in same practice not involved continued to increase their use of GPs and those who took up the offer of social intervention dramatically used it less with almost immediate effect.

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