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Why is NHS England counting the number of people who have been “socially prescribed”?

January 13, 2020

How do we strengthen the connection between citizens and communities and health services so that we create the best environment to improve health and wellbeing? We know we need to do it in a way that recognises peoples social and economic circumstances and builds on their strengths and the strength of their communities.

NHS England plans to meet this challenge through primary care implementing it’s strategy – Universal Personalised Care.

Central to the strategy are the groups of general practice established by NHS England – Primary Care Networks. These cover populations of 30 to 50 thousand and their role is set out in a new contract. NHSE is currently consulting on the specification for the contract.

You can comment but be quick!!! The consultation ends on the 15th of January 2020 so look and comment – here!

Part of the contract is about Social Prescribing. Before, I comment on this I want to build on my previous blog and set out the current challenges faced by social prescribing.

Social Prescribing is:

  • trying to break the barrier between clinician and community by providing a route for General Practice to connect people with other people  and resources in their community.
  • only going to be successful if GPs and their team change the way they work – to better understand how to build on personal strengths and what communities have or could have.
  • in danger of putting more pressure on poorly funded community resources and the voluntary sector.

So, if we want social prescribing to be effective we need to create a local narrative that helps us to understand what is happening in a way that:

  • helps General Practice change its culture
  • motivates GPs, citizens and community organisations to engage with it
  • brings what citizens can do for themselves or with others to the fore
  • keeps funders local and national informed about the effect that social prescribing is having on community infrastructure

This is fundamentally a local issue.

What we need to do

We therefore need to create a sophisticated but straightforward mechanism to ensure that there is feedback coming back on the difference that social prescribing is making and how it can be improved.

The primary audience for this feedback must be:

  • the GPs working in a particular network
  • the people who have used social prescribing
  • the community organisations who are working in that area
  • other voluntary organisations
  • Local Funders

What NHS England are proposing in the consultation

In the PCN Network contract specification NHS England are proposing that Primary Care Networks report on the number of people who have been ‘socially prescribed’ and that this minimum target should rise each year as follows:

20/21 – 4-8 social prescribing referrals per 1,000 weighted population

21/22 – 8-12 SPR/1,000 WP

22/23 – 12-16 SPR/1000 WP

23/24 – 16-22 SPR/1000 WP

This simple quantitative target is purely about activity it tells us nothing about where people went, what their needs were, what difference this “prescription” made to their lives and what costs the referral placed on others such as the community or the voluntary sector.

These metrics only feed Whitehall – they give an illusion of impact but only count activity.

Quantitative performance management like this is completely at odds with an initiative that aspires to change relationships and bring quality to life.

What we need

I suggest that Instead every primary care network is required to hold a yearly workshop with people who have received “social prescriptions” local community organisations and local voluntary sector. This meeting should discuss the difference that social prescribing made, the challenges that it faced and the actions that need to be taken to improve it.

The report from this meeting should go to the practices in the PCN, the CCG and to NHS England. The National Academy for Social Prescribing should be required to analyse these and produce recommendations back to DHSC and NHS England.

What do you think?

Acknowledgement – thanks to Charlotte Augst CE of National Voices for the ‘heads up’ and the inspiring conversation

5 Comments leave one →
  1. January 13, 2020 08:12

    Great blog Mark. You’re right, the qualitative element on social prescribing, how people feel, experience and respond are so much more important.

    I’d like to see analysis of changes in subjective wellbeing of patients engaging with social prescribing.

  2. Nicola Kingston permalink
    January 13, 2020 09:09

    Think this is a great idea, and would very much support this if you send this in as a response to the consultation?

  3. January 13, 2020 10:08

    I agree with you, Mark. It’s hard to believe that such crude measurement is being proposed that does nothing to support the development of SP nor the experience of those potentially benefiting. Tick box counting is soooo last century!

  4. January 13, 2020 19:42

    Another difficulty with measuring the outcome of social prescribing is that there is a preventative element to it, eg. to cut down on the amount of appointments with GPs and to stop problems building up that might make worse any mental health issues in the future. Quantitative measures for an absence of a future event are very hard to measure. However, just counting people is no substitute for that. At the very least there needs to be outcomes measured, and I know some social prescribers are already doing this off their own back.

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