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GPs buried under trusts' workload dump

GP practices could receive £1 per patient to fund social prescribing advisor

Exclusive General practice could receive an extra £1 per patient towards improving access to social prescribing by 2017/18, according to NHS England’s clinical champion for social prescribing.

Dr Michael Dixon told Pulse that he was in talks with commissioners about the extra funding, which would pay for practices to employ a social prescribing ‘advisor’ that would provide GPs with the means for offering patients a ‘solution that isn’t medicine or a procedure’.

The advisor would direct patients facing issues such as loneliness to appropriate support services in the area.

Dr Dixon said the scheme, which has been ‘met with interest and positivity’ by the health secretary and others at NHS England, would reduce workload pressure on GPs, who are currently ‘under siege’.

He said: ‘It’s believed, first of all, that social prescribing works and is not only important for patients but also very important for general practice because, where it works well, it is reducing pressure on general practice.’

Dr Dixon, who is also a GP in Devon, funds a social prescribing advisor in his own practice of 20,000 patients, which he said costs £23,000 each year to run.

He said: ‘If we really want to kick start this and get this going, I think a pound per patient would do it and that's actually pretty tiny when you think about the amount that’s gone into other initiatives.' 

He added that the funding should have ‘no strings attached’ and instead ‘should just be an extra service they can provide which is paid for by the CCG’.

Dr Dixon said GPs should be able to access advisors several ways, including a ‘practice-attached’ advisor that is paid for by the CCG or a ‘hub and spoke’ system for smaller practices where advisors go out to visit practices.

Dr Dixon said he would ‘very much hope’ the extra funding to be in place by 2017/18 ‘at the very latest’.

But he said details of how the funding will be delivered, whether centrally or through STPs, is what is ‘holding things up at the moment’.

However, there have been recent studies that have cast doubt on the effectiveness of social prescribing.

A review by York University health economists, published last year, concluded that only few studies had supported the use of social prescribing, all of which were of ‘poor quality’.

The researchers said: ‘There is little in the way of supporting evidence of effect to inform the commissioning of a social prescribing programme.

‘What evidence there is tends to briefly describe the evaluation of small-scale pilot projects but fails to provide sufficient detail to judge either success or value for money. Evidence on the cost effectiveness of social prescribing schemes is lacking.’

Another recent study from NHS City and Hackney CCG, in east London, analysed data on healthcare use, GP attendance and prescriptions for 381 patients referred to its social prescribing pilot and found that referred patients had much higher consultation rates and used more prescription medications before referral than controls and this remained the case eight months after referral to the scheme.

Dr Sally Hull, a GP and reader in primary care development at Queen Mary University London who led a review of 381 patients referred to social prescribing pilots in NHS City and Hackney CCG, ‘there was no demonstrable impact on GP consultation rates’ and ‘we were not able to show a change in outcomes such as levels of depression, anxiety or confidence in self-management’.

NHS England included social prescribing in their ‘10 High Impact Actions’ to release GP time launched in July, but said they were not aware of any current work to progress funding allocation for social prescribing.

Readers' comments (43)

  • Only one question: -
    Who else would take on a contract for £1 PER YEAR PER PERSON??!!
    I'm starting to think someone's putting STP in my tea. This getting very weird...

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  • Will this extra work be forced onto GPs even if they do not want to take Hunt's farthing?

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  • 20k patients costs £23k...hmmm seems less than £1 per patient....maths clearly not strong point.

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  • I heard cardigans sold out in many stores this black friday.

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  • Took Early Retirement

    He's doing it already? Out of his own money? Strange.

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  • Took Early Retirement

    "Michael Dixon graduated in psychology and philosophy at Oxford University before studying medicine at Guy’s Hospital. Since 1984 he has been a general practitioner at College Surgery in Cullompton, Devon. In 2008, he and his partners created the “Culm Valley Integrated Centre for Health”, which is widely regarded as a prototype for general practice of the future.

    Since the early 1990s, he has been a leader of the GP/clinical commissioning movement with its aim of allowing frontline clinicians a far greater role in improving local services and health. He co-founded one of the first Locality Commissioning Groups in Mid Devon in 1993 and served on the National Executive of the National Association of GPs before becoming the first chair of its successor organisation, the NHS Alliance, in 1998. He has continued in this role, by annual election, to the present day. In 2012, clinical commissioning was fully embedded in statute with the creation of Clinical Commissioning Groups (CCGs). A new organisation, NHS Clinical Commissioners” was created to represent CCGs bringing together the commissioning “arms” of NHS Alliance, NHS Confederation and the National Association of Primary Care. Michael is the acting president of this new organisation.

    Recent national roles have included:- chair of the National LifeCheck Board, special advisor on Practice Based Commissioning to Lord Darzi and sitting on the steering group of the recent King’s Fund Enquiry into the future of general practice. Today, he is a member of the National Stakeholder Forum, sits on the National Steering Group and the National Strategy Group for Clinical Commissioning. He is also a member of the NHS Sustainable Development Unit National Advisory Group.

    Since 2007, he has been visiting professor to the University of Westminster(Integrated School of Health) and was also appointed visiting professor of University College,London in 2012. He is an honorary senior fellow in Public Policy at HSMC (University of Birmingham) and honorary senior lecturer in Integrated Health at the Peninsula Medical School. He is a regular writer and broadcaster, having written several books including “The Human Effect in Medicine” and is president of the Health Writers Guild."

    Not much time to be an "ordinary" GP one might think?

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  • Blimey - if he can manage all that why is everyone else moaning about just the GP workload!

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  • Vinci Ho

    So much I would like to know the details.......
    GP practices could receive £1 per patient to fund social prescribing advisor+

    GPs set for new enhanced service for urgent home visits under NHS plans+

    NHS chief executive wants 'one-stop' GP practices to do 'all of the -ologies'

    If you add these three ingredients all together , what is the end product you gonna see?
    A powerful 'machinery' called general practice which could stop many patients going to secondary care at all departments, most important of which is called Accident and Emergency . In addition, it is to safeguard the financially well starved social care .This is a morally correct aspiration as our patients would presumably ,prefer to stay away from hospitals and being looked after at home . This is fundamentally a noble ideology reinvigorating our longing of a primary care led health service.
    But the 'right' thing only happens at the right time and the right place . Perhaps , this big 'machinery' should have been built in a gradual fashion seven or eight years ago when NHS was in a relatively stable and healthy condition(even though just after the crash of the banking sector). Fast forward to today , the historical mission of Simon Stevens , the Messiah , is to build this new general practice infrastructure in short space of time in the backdrop of almost all NHS acute trusts in deep financial problems.
    The £120 billions(amount this government had to borrow)question here is what are the 'tools' the Messiah would use to build such a machine for it to be fit for purpose? Money , expertise and manpower. One for all , all for one.
    Well , the truth revealed by the Health Select Committee in House of Commons and the 'not so surprising' NHS left out - Autumn Statement told you all about money . Expertise wise , one will need more consultants(their NHS contract yet to be sorted)coming out into communities to work as well as focused GP expansionists(remember Nigel's classification of us?) to sail the yacht in a motionless sea with very little wind blowing in the right direction. Manpower begs the question of how the government can recruit and more essentially , retain medical professionals( arguably receiving little respects from our politicians ) when the morale is historically low .
    Simon Stevens is no doubt, an expansionist with optimism from the outset. The vision of 'doing things differently', hence transformation, was respectable but again , it was about right time and right place and politics always carries the burden of convincing your colleagues and the public . Behind the doors , he simply banged his head on the wall more than once when both both pairs of his big bosses , namely Cameron/Osbourne and May/Hammond , laughed him off for the extra new money needed for his grand plans for the five years forward of NHS and general practice. Colleagues not so convinced, I suppose .
    To convince the public , he needs more expansionists to help spreading his ideology and that spice of optimism is vital . I cannot help equating the temperature of this optimism with that of Brexiteers on the future of our economy. In fact , the Chancellor was labelled as pessimistic and gloomy by the propaganda media of his own party . How often have we seen the backbencher senior MP from the same party of the Chancellor stood up and simply accused the chancellor of scaremongering with an overestimated figure of how much money the government would have to borrow? 'Thank you for stabbing me in the back ,John!'. If the attack of IDS on Osbourne was cunning , this was purely embarrassing.
    So the figure of £120 billions borrowing with half of that (around £60billions) due to Brexit ,according to the Chancellor ,could be wrong but one can argue that giving 10 out of this 60 billions real money to NHS is not too insensible ,especially optimism should be the word. The Neo-Keynesian approach could easily include saving NHS.Then Stevens could insist that his grand plans would sustain and transform NHS, the true STP would be .
    Instead , this current status quo situation of NHS will collapse unless drastic rationing and saving are to be made , the real S(T)P. Yes , some money would be given to general practice because far more substantial cuts in secondary care will happen . The workload will be picked up by this GP machinery with the golden flag of 'integrated care' flying on top of it . Expansionists would tell you things were already successful in pilot sites by doing things differently and more money could be saved .
    While I agree that the pessimism of reductionists will not provide a solution , true integrated care can gradually improve efficiency with medium to long term saving ONLY if it is implemented at a time of stability . S(T)P is clearly a sign of the times at the midst of chaos and desperation . Reducing the budget of public health ,forcing the termination of smoking cessation and sexual health services ,represented the hypocrisy of investing for long term health benefits. We care about our patients but the government only cares about savings.
    For those politicians who still know the meaning of 'honour' (not the Secretary of State who only knows how to be a good servant) as well as Simon Stevens , I challenge you to stand up for NHS in the forthcoming parliamentary debate(which I believe the Supreme Court will give the right verdict) negotiating terms and conditions of Brexit actual.
    We were arguing about the question ,'crisis,what crisis?' 18 months ago . Now , the question may be ' to be or not to be?' instead , whether you are an expansionist or reductionist .
    We are living in a land where the emperor had bought some new clothes, can you see them? I don't have the answer.....

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  • "What I tell you three times is true" The Bellman- Hunting of the Snark

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  • In these days of competitive trading, shouldn't we be looking at health like being at a Car Boot Sale? I.e. GP Practices to receive a £1 - "Will you take 50p?" "Hang on a minute, the bloke over there is doing Social What yer ma call it for 20pence including a vintage VHS recorder!!!!"

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