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