Now 'social prescribing' is helping keep people in Northumberland healthy all round

It is a broad term for signposting people to anything that can help their wellbeing – whether it’s exercise, a social or creative group or specialist support when needed.

It is one of the concepts being pushed by the NHS as part of the wider focus on prevention and a wider shift in healthcare to avoid always going down the medical route to resolve issues, when other paths may be more beneficial.

Northumberland County Council in partnership with NHS community services has had what it calls support workers for around a decade now, carrying out a social-referral role, but the NHS Long Term Plan (LTP) and the General Practice Forward View have enabled the consolidation of what’s happening in the county, according to health bosses.

“Across Northumberland, because we had such a good start with regards to what’s being going on with the local authority with support planners, this was a good way to consolidate everything around the needs of social referral,” said Pamela Phelps, senior head of commissioning for primary care at NHS Northumberland Clinical Commissioning Group (CCG).

The GP Forward View provided funding from 2017-18 for care navigators, a signposting service, while the LTP seeks to embed social prescribing within the new primary care networks – groups of GP practices working together to enable economies of scale and additional services to be provided – with NHS England set to fund 1,000 link workers, a similar idea to the support workers.

Pamela added: “The roles from those perspectives are quite new; we are looking to develop the care navigation in general practices, but also working with the social prescribing link workers at a primary care network level, where they will focus on their neighbourhoods and the communities they will cover in those neighbourhoods.”

Northumberland’s support planners are very well-embedded, so they are going to be acting as mentors for the new posts, explained Debra Dodds, operations manager for prevention at Northumbria Healthcare NHS Foundation Trust.

“It’s about having an excellent network for signposting, having that local knowledge, what’s tried and tested and has worked with other patients,” she said. “That’s why we’re so keen to use the experience of the existing support planners with the link workers and care navigators.”

Last month, a study was published which sparked national news headlines along the lines of the benefits of social prescribing of exercise being smaller than thought.

Appearing in the Journal of Epidemiology and Community Health, it claimed that exercise referral schemes lead to small improvements in patient health, but the size of these changes are not ‘clinically meaningful’.

A team of researchers measured health outcomes in patients before and after they took part in an exercise scheme and found that while most of the outcomes showed statistically significant improvements, their impact was ‘unclear’.

The authors wrote: “These findings support the need to consider exercise referral schemes, particularly their implementation, more critically using real-world data to understand how best to maximise their potential, particularly considering the known benefits of exercise and the reach of the schemes across the UK.”

However, Debra explained that a more universal approach was the one favoured in Northumberland anyway.

“It’s about finding out what the person wants really than having a preconceived idea that we are going to prescribe exercise when actually it might not be exercise that they need,” she said. “It’s better to sit down with someone and find out what it is they need or want, that’s the way we have always looked at it.

“In some local authorities, they will focus on just one area such as exercise, but in Northumberland, we have looked in the past at anything that comes through our Onecall system (the 24/7 phone line providing a single point of access for referrals to a wide range of community health and social-care services in the county), so you could get a referral from someone who wants some advice and information around what’s available in the area, because they are worried about mum who’s been recently bereaved and what she might be able to do to fill her days with,” she said.

Other examples of what the support workers have done includes supporting people to set up their own groups for hobbies they share with others and helping residents to get attendance allowance; one woman received a back payment which she used to gravel her garden, meaning it was easier to maintain, so she could stay in her own home. She uses the weekly payments to pay for taxis to go shopping and a cleaner so that she keeps that independence.

In another case, a woman who was severely depressed was linked into volunteering for a group for young girls with learning disabilities, which has given her a purpose, what she described as a lifeline, and it has led to a reduction in her medication.

Pamela said: “There’s Active Northumberland, so there are exercise schemes across the county, but this isn’t about exercise necessarily, this is about tailoring the needs of each individual patient and the support that the support and link workers can connect them with.”

Alan Bell, head of commissioning at the CCG, added: “We are treating each patient as an individual and exploring their needs if they are accessing GP services, talking to reception staff at GP practices, link workers or in hospital.

“It’s about understanding what that person’s issues are and some of it might be social, some might be medical or a mixture of both. Some will have multiple long-term conditions and it’s about trying to deal with all those and looking at the whole picture of that person.”

Sharing similar views in his response to the study mentioned above, Coun Ian Hudspeth, chairman of the Local Government Association’s community wellbeing board, said: “Social-prescribing schemes remain in their relative infancy on a national scale, but are becoming increasingly popular as councils look to embed preventative approaches in the services that they provide.

“Locally-led, targeted interventions and facilities, such as museums, libraries, leisure centres and parks, have a major role to play in helping communities to become creative and physically active.

“Wellbeing is complicated and hard to measure. Outcomes can differ widely from one individual to another and are unpredictable. It is important that any social-prescribing activity is properly resourced to allow evaluation and research to take place.”