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At the heart of general practice since 1960

Should GPs bother with social prescribing?

Sir Sam Everington argues that social prescribing is an easy alternative to medication, while Dr Des Spence argues it is patronising and will achieve nothing

Sam Everington

YES

Social prescribing, for the first time, gives GPs hundreds of further treatment options without increasing their workload. It is based on the concept that 70% of health outcomes are delivered by the wider social determinants of health, not by traditional NHS services. GPs can refer patients to the service that will best suit their needs, for example exercise, housing services or, as recommended by a new report from The King’s Fund, gardening. These can improve health and decrease our workload later on.

Whether or not a 75-year-old patient with a painful and degenerative knee ends up with knee replacement surgery can depend more on who they are referred to than the level of degeneration. Alternative social prescribing options can help tackle the pain and disability and reduce the need for hospital referral.

Social prescribing also supports the voluntary sector as it reduces the need to market projects to staff in the NHS and local authorities. From a commissioning perspective it focuses on what matters to patients. This increases satisfaction, delivers better health outcomes and reduces prescribing and referral costs.¹

And social prescribing can be easy for GPs, and even reduce our workload. Eight practices in Tower Hamlets have a social prescribing referral form on the GPs’ computers alongside the others such as two-week waits. In a 10-minute consultation GPs need only to tick the most suitable option, including health trainers, employment advice or housing issues. They can even describe the problem on the referral form and email it to the social prescribing team, meaning they don’t need to remember all the services available – in Tower Hamlets alone, there are 1,500 voluntary sector organisations. A similar system could easily be set up elsewhere.

Feedback from GPs has been very positive. It gives an alternative to medication and hospital referral and reduces pressure from patients with complex needs. It changes the approach from ‘what is the matter with you’ to ‘what matters to you’.

Many would say the ideal is that patients self-refer to these services, and they can. But many struggle to do so due to poor health. Early evidence indicates social prescribing reduces consultation rates and gives GPs the option to offer non-biomedical treatment when they are under pressure to address a patient’s problems within a short consultation.

Sir Sam Everington is chair of NHS Tower Hamlets CCG, east London, and a GP in the borough

Dr Des Spence

NO

Social prescribing – GPs making exercise referrals, suggesting an angling club or a basket-weaving course – is a waste of time and will achieve nothing.

Frequently, commentators suggest that GPs could be a social hub and ‘signpost’ patients to local services or use prescription-style referrals. This is hardly a new idea and is what GPs have been doing informally for years. For the core function of general practice has always been to dispense common sense, to point out the obvious to the oblivious and to de-escalate the illogical advice of our hospital colleges. But now there seems a need to formalise these intangible aspects of the job, no doubt fuelled by an expert academic GP department seeking ‘research’ grants.

But we should be wary of well-intentioned, corduroy ‘good ideas’. The QOF was supposed to be a revolution in care that would eradicate cardiovascular disease and diabetes in a decade. Some even suggested it would reduce our workload in the long term. This was all based on robust academic ‘evidence’. But the QOF unleashed academic mayhem that nearly broke general practice, choking our surgeries with the unnecessary recalls for the worried well, while the unworried unwell couldn’t get appointments. And a decade later it has made no clinical difference despite the tens of billions of pounds spent.

Social prescribing is of this ilk. Its advocates suggest that it might reduce our workload by directing patients to non-medical solutions. But the best-studied social prescribing is for exercise referral and there is no evidence this increases activity, reduces weight or is cost effective. There is no evidence that doctor-initiated ‘social prescribing’ changes anything. And how much would it cost? How much time will it take? Who will keep information up to date? Will it become yet another meaningless tick-box activity? Wouldn’t other agencies be better placed to provide these referrals?

Finally, social prescribing seems patronising. Patients aren’t stupid; they know what they need to do. And if they want to find out about local services there is something called the internet. Medicine has a long history of good ideas gone wrong because of overstated and unrealistic expectations. Let’s nip the green shoots of social prescribing in the bud.

Dr Des Spence is a GP in Maryhill, Glasgow, and a tutor at the University of Glasgow

Reference

1. Report of the annual social prescribing network conference. 2016 tinyurl.com/gkqjltx

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Readers' comments (12)

  • More bleeding hearts who think GPs should now be a gateway to social services. You naive people, all you will do is generate extra demand from the inadequates who now think you are their social worker and will want appointments with GPs to get referred on to non-medical services, thereby depriving people with real medical need of an appt with the GP.

    For goodness sake stop trying to be so fluffy popular, and just get on with being a medical doctor, and stop dragging the standing of the profession down into being a glorified social worker clerk.

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  • Practice Manager 11:09am
    Totally agree

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  • I didn't spend 8 years in medical school & GP Training just to tell patients what they should already know as part of common sense.

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  • This comment has been moderated

  • There is a great danger if a GP referral has more weight than a self referral, as a social script will become the new ticket to services in the way a med cert entitles housing benefit in the unemployable.

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  • Completely agree with above views.
    What's the Citizens Advice Bureau for anyhow?
    Just give existing services such as libraries and CAB more resources.
    Oh no I forgot the libraries are being shut down in many areas. So much for Cameron's caring society.
    Keep these people out of our surgeries, and definitely out of my consulting room.

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  • Practice manager @ 11:09am

    Truer words have never been spoken.

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  • How very patronising....1,500 voluntary orgs benefitting from this in tower hamlets.. making fools of the people who live there..soryy Sir you don't need to invent this rubbish to justify your gong

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  • Sadly what this article does not tease out is that are two separate issues here
    1. does social prescribing work?
    2. is general practice the best place to social prescribe from?

    the answer is yes to 1
    the answer is occasionally but usually via other routes to 2

    the reality as highlighted by one of the comments is that people should know about these services and the key is just to make them visible and create a directory and put a hub navigator behind a phone line as needed - that is what we have done in Wandsworth and this is not dependent on a GP socially prescribing at all. People just go direct

    dependency on GPs to be the referral point for everything is pointless and frankly part of the reason why primary care is on a knife edge and overloaded - we simply are a hub for.. well ... everything!

    However when you see the richness and possibilities out there in the third sector, communities, community leaders, carers it is really quite striking. the impacts are and can be huge but the routes by which people get to these alternative services should be direct in most cases.
    Furthermore having a directory of third sector and other resources in front of you as you care plan is very very powerful. Not only that it becomes a resource for social services, acute services, secondary care, your local IAPT and mental health trust and will furthermore support your personalisation personal health budget agenda.

    You should also supplement your population with self management and self care capability and that is the magic we have never fully realised. look to the five year forward view....

    so less dependency on GPs for the referrals although social prescribing can support what you do as Sam says.
    Implant the opportunity to use other sectors of service out there directly available for your population

    so everyone is right - also look to the evidence on social prescribing. particularly powerful around mental health and that is 1 in 4 consultations if the data is correct...

    worth a look I think

    P;)

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  • We have a social prescribing hub in the surgery. We can refer patients to it and it is GREAT.

    What I notice, as a busy GP, is that when I have the patient who comes back to me again and again about trivia, I refer to social prescribing and the wonderful man works out what the real problem is. He gets calls from my frequent flyers twice a week instead of them calling me - he has sorted out gas bills, eviction threats, application forms for people who can't read or write, amongst other things.

    This makes a big difference to a small number of people, but the person it makes the biggest difference to is me - these people go from being frequent attending and demanding heartsinks (I know it's not PC to say so, but you all know what I mean), back to being vulnerable people with medical problems, and seeing me about the medical issues. Sorting out the anxiety about the gas bill sorted out a lot of the general anxiety that caused that person to phone the surgery to speak to me virtually every day I was there - I have not had a call for a few months now, and our social prescriber has arranged support for them on an ongoing basis.

    The GPs who don't use this service, or don't have access to it should speak those of us who do. My experience is entirely positive. Our social prescriber has the most common sense of anyone I have ever met in the NHS and allied professions, and sees his role as reducing my workload by helping my patients get back in control.

    A massive thank you to the social prescribers out there!

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  • Oh, and by the way, it is not just the GPs who can refer - many of our referrals to social prescribing have come from receptionists, of ten when patients have asked for help which isn't in the GP realm, or just because they are aware what is on offer and know the patients.

    Don't knock it till you've tried it.

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