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Gold, incentives and meh

Why social prescribing needs to be given a chance

Letter from Dr Marcello Bertotti, Senior Research Fellow, Institute for Health and Human Development, University of East London

I am writing in response to the article entitled 'Social prescribing scheme "did not cut GP workload or improve patients" health' published in Pulse in August. This article drew heavily on evidence produced by an evaluation of social prescribing in City and Hackney led by the University of East London and Queen Mary University of London. As one of the leads of that evaluation, I want to highlight another side to the story.

Sally Hull, a colleague involved in the evaluation and interviewed as part of the initial Pulse article, concluded that we need more rigorous research to establish the impact of social prescribing rather than arguing that social prescribing is not cost-effective or beneficial for patients.

We also concluded that the evidence shows a gap between qualitative and quantitative evidence with the former showing much more positive results than the latter. However, the article does not even mention the results from the qualitative research and is instead solely guided by the results from the quantitative work.

Furthermore, recent long term analysis conducted by Queen Mary University showed a statistically significant reduction in GP consultation rates one year post referral when compared with a matched control group, which actually saw an increase in GP consultation rates. Although these results suffer from a potential problem with ‘regression to the mean’, it does show that we cannot be conclusive either way and also shows that the impact of social prescribing on patients may take longer than initially anticipated.

Social prescribing seems to have rapidly become a ground for ideological battle with critical comments about waste of NHS resources, and GP comments about ‘we are doing it anyway’, or ‘patients are not stupid, they can use the internet’. Social prescribing is there to support and assist GPs and should not be seen as the enemy. Whether some GPs like it or not, 20% of patients consult their GP for problems that are primarily social rather than medical which suggests that referral to non-clinical treatment available in the community may be helpful. A social prescribing link worker can act as an interface between primary care and the third sector and provide patients with time to explore their feeling, something that is not currently possible during busy GP consultations.

Although I would not want to deny that social prescribing has its limitations and needs further improvement, it is important to give it a fair chance to prove its potential worth rather than attempting to kill it with only one side of the story.

If you would like to write to Pulse, please email

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Readers' comments (7)

  • GPs prescribe medicines or treatments with which they are familiar and have a sound evidence base.
    Patients can trust our prescriptions to be the best available.
    As you have said there is a very poor evidence base for social prescribing.
    Thus patients cannot trust a social prescription and we should not be offering one.
    We should continue to signpost to available services without giving them the stamp of our approval.

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  • Quote "It's been independently shown that GPs are in poor compliance with evidence-based hypertension guidelines and are undertreating hypertension [2] and, despite being aware of the risks of hypertension in the elderly and the benefits of its treatment, with fewer than half complying with the broad recommendations of even the most conservative evidence-based guidelines [3,4], a problem widespread among GPs in the UK and elsewhere [5]."

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  • Another one - EBM in PC

    Objective To explore the factors, including barriers and facilitators, influencing the practice of evidence-based medicine (EBM) across various primary care settings in Malaysia based on the doctors’ views and experiences.

    Research design The qualitative study was used to answer the research question. 37 primary care physicians participated in six focus group discussions and six individual in-depth interviews. A semistructured topic guide was used to facilitate both the interviews and focus groups, which were audio recorded, transcribed verbatim, checked and analysed using a thematic approach.

    Participants 37 primary care doctors including medical officers, family medicine specialists, primary care lecturers and general practitioners with different working experiences and in different settings.

    Setting The study was conducted across three primary care settings—an academic primary care practice, private and public health clinics in Klang Valley, Malaysia.

    Results The doctors in this study were aware of the importance of EBM but seldom practised it. Three main factors influenced the implementation of EBM in the doctors’ daily practice. First, there was a lack of knowledge and skills in searching for and applying evidence. Second, workplace culture influenced doctors’ practice of EBM. Third, some doctors considered EBM as a threat to good clinical practice. They were concerned that rigid application of evidence compromised personalised patient care and felt that EBM did not consider the importance of clinical experience.

    Conclusions Despite being aware of and having a positive attitude towards EBM, doctors in this study seldom practised EBM in their routine clinical practice. Besides commonly cited barriers such as having a heavy workload and lack of training, workplace ‘EBM culture’ had an important influence on the doctors’ behaviour. Strategies targeting barriers at the practice level should be considered when implementing EBM in primary care.

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  • Social prescribing has helped me in my practice, with some of my more challenging patients where I feel they are coming to me with social problems I have no control over. I have someone else to direct them to, to help them through the complex processes.
    Don't knock it till you've tried it.

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  • I don't want to be encouraging any one to come to see me in the hope of a social prescription. Sure 1/3 of consultations may be for social reasons but that isn't a reason to make this a designated part of the job. We are here to treat medical illness, forever we are being asked to do other stuff buy other people mainly because it's convenient for them and seen as 'cheap'. We aren't here for 'everything' . We aren't social workers, I don't work for the DWP, we aren't the medical arm of travel and life insurance companies, we aren't the attendance inforcement department of the local school or the gun registration enforcer for the police force...but it is highly convenient for such folk to delegate expensive and awkward parts of what they do to us to save them time, money and the bother of doing it them selves. This directly impacts on our ability to do what we are actually here to do...treat medical illness. This is just another example of an attempt to try to expand our role for the convenience of services that should be doing this themselves, but aren't ...probably because they too aren't adequately funded. Wake up..we aren't funded adequately either!

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  • Lots of unintended consequences here...
    - Regulatory/QA framework for the mostly voluntary services you refer to?
    - Safety and governance?
    - How you prevent stoking demand for GP access to reach these wonder-cures.

    All I have seen is vague, warm and fuzzy. Lots of great intentions and ideas, but lacking rigour and drive.

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  • I fear that the advocates of social prescribing are not seeing the bigger picture. By taking on this role they change the role and society's perception of GPS from that of being highly trained medical doctors to that of being a signposting clerk to social and welfare services. Thus they will demean the job of being a GP and will reinforce the training schools' bias against the "lowly" GP. The number of consultations for social problems will quickly rise from its current 20% as the public realisethey have a new way to abuse and overload "free" General practice. Is the damage that social prescribing will do to the profession really worth the warm feeling that some "I need to be loved" GPs will get? I think this must be resisted very firmly.

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