At the moment it feels like the answer to virtually all of society’s woes is ‘get GPs to prescribe…’.
Want to make people happier? Get GPs to prescribe books. Got money problems? Get your GP to prescribe some debt advice. The latest is the solution to Britain’s obesity problem – get GPs to prescribe slimming classes.
Yes, social prescribing has an important role to play. I prescribe adaptations like grab rails and wheelchair ramps regularly because I know they will improve a patient’s home life, help them to live independently and reduce the chances of them needing to visit my surgery (or, worse, ending up in hospital).
My practice is in a disadvantaged area of Liverpool and many of my patients have conditions that relate to poor housing. Prescribing home modifications has the potential to get to the heart of the problem, avoid constant intervention and, in the long run, negate the need for expensive medication that treats only the symptoms.
However, the referral process is a bureaucratic nightmare. It’s time-consuming, complex and unwieldy. I have to write long letters and make numerous phone calls for every referral and it takes time that I really can’t afford – even though a grab rail will prevent a fractured hip, a new boiler will help someone manage their respiratory problems and navigation aids will stop a visually impaired person from falling and suffering needless injury.
But it’s frustrating because I have to start from scratch each time when the referral system could, quite easily, be far more efficient.
An agency model
For social prescribing to be embraced, we need to make the process quicker and an awful lot simpler.
The most straightforward way to achieve this is to streamline referrals by turning surgeries into one-stop-shops or community hubs where patients can access a range of information and advice.
Gone will be the days of me writing a letter to ensure my patient gets a grant so the local home improvement agency can repair her staircase.
Instead, my practice team – nurses, practice managers and receptionists – will be the gateway or conduit to accessing housing support via the ‘community hub’ that our surgery has become.
For example, patients can book in with agencies providing support like occupational therapy or handyperson services via the GP receptionist, which would take the workload off GPs. This would also fit well with potential opportunities for joint commissioning between GPs and bodies like charities and councils.
Increasingly, it makes sense for cross-sector partnerships to deliver public health services, particularly around hospital discharge and prevention. Agencies already helping vulnerable people to live independently at home by delivering telecare, supported housing, home adaptations and transport services are ideally placed to work with GPs to achieve key health outcomes such as reducing unplanned hospitalisation for chronic conditions.
Improving this partnership working and the social prescribing system as a whole might also help to identify patients with a higher than normal risk who may need primary or acute services on a frequent basis. With more GPs now embracing this notion of risk stratification, high-risk patients who could benefit from targeted support can now be identified with greater certainty.
And that in turns means NHS England, for example, can make better informed judgements on how and where scarce resources should be assigned to best effect.
Going forward, braver commissioning is needed if we’re to move towards a health system that genuinely prioritises prevention and more GPs need to prescribe home-based support.
But that’s only going to happen if we have a referral process for social care that is fit for purpose, rather than the long-winded, administrative ordeal we have at present.
Dr Faisal Majeed is a GP in Liverpool.
