While welcomed in some quarters the NHS Long Term Plan has come in for a fair amount of criticism for its lack of strategic heft and poor focus on the relationship that the NHS must have with external partners such as local government and the voluntary and community sector.
One of the areas where it does recognise the importance of making connections between communities, their assets and the voluntary sector is with regard to Social Prescribing.
Social Prescribing has developed a fair amount of traction in the NHS. Indeed, the term itself speaks to front line health professionals such GPs, it uses their language and it has gathered around it some significant champions such as Dr Michael Dixon who was also the founding Chair of the NHS Alliance.
This is what the NHS Long Term Plan says:
I think this means that by 2023/4 900,000 people a year will be offered Social Prescribing by the NHS. Note the commitment to 1,000 social prescribing link workers. I have allocated them by population size of CCG so for example Sheffield get 10 and Corby 1 (my full CCG list is here) of course doing it this way takes no account of inequality. The statement about NHS Social Prescribing Link workers has generated anxiety in the voluntary sector who are the main providers currently – with concern that these will be NHS employees.
At the moment there are about 59.7 million patients registered with GPs who make over 240 million appointments a year. compared to the 900,000 a year promised for Social Prescribing. This means that in 5 years time social prescribing activity will be equivalent to .38% of appointments at GPs. Here is an illustration of the scale of this.
If you are an average patient and see your GP four times a year the odds of you being offered a Social Prescribing appointment are approximately once in every 60 years!
Of course it is fairer to say that not everyone who sees a GP will need or want referral to social prescribing. It is probably more realistic to focus on people with multi morbidity. A recent study by the Department of Public Health and Primary Care at the University of Cambridge showed that over half of GP consultations are now with patients with multi-morbidity – this equates to 120m appointments a year.
The pie chart below shows how the NHS England social prescribing commitment would impact on this challenge. It is clear that the current NHSE commitment still gets nowhere near – indeed it could be said that the NHSE response is so diluted and small that it will be almost homeopathic in terms of its system level effect!
Real scale of the challenge
I mentioned in an earlier blog on Welfare Rights and Health that a joint paper produced by Citizens Advice and the Royal College of General Practice estimated that approximately 20% of GP time was spent with patients who presented with non clinical issues that would be better addressed elsewhere.
I think that this proportion is likely to be much greater with when General Practice is providing a service to disadvantaged communities who are likely to have to higher levels of multi-morbidity and a greater level of non clinical issues.
Finally there is a subsidiary point even a small target of just under a million people receiving social prescribing services will have a knock on effect to voluntary sector services. Some existing social prescribing services such as Rotherham have a degree of funding that recognises this. The NHSE 10 year plan does not seem to recognise this.
What this means
The current ambition set out in the Long Term Plan leaves social prescribing as a bit of a sideshow for the next 5 years. There is a real risk that once the magical 900,000 a year target is met that the foot comes off the gas – with little having been achieved.
- Maybe this level of ambition matches need?
- Perhaps only 1% of people who see GPs require social prescribing?
- If it is only a minority interest then should more thought be given to ensure that this investment is reaching out to those who would benefit most rather than being generally available?
- Given the small scale of investment are there other interventions such as Local Area Coordination, Community Development and Health Trainers that might have a greater impact that should be considered by NHS England too?
What do you think?