28/09/2015

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Social Prescribing in Practice

Matt Pearce

Senior Commissioning Manager

Gloucestershire CCG

Helen Edwards

Local Implementation Manager

Gloucestershire CCG

28/09/2015

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Demographic context

• Population of approximate 629,000

• GCCG, local authorities, community provider, acute provider and

mental health provider co-terminus

• One upper tier council and six lower tier councils

• Around 2% of the county’s population live in areas considered to be

amongst the most deprived 10% in the

country

• Gloucestershire has an ageing population

• As the age profile of the population increases, so does the number of people living with long-term conditions

“Health is a state of complete physical, mental and social

well-being and not merely the absence of disease or

infirmity.”

World Health Organisation 1948

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Social circumstances, 15%

Environmental exposure, 5%

Health care, 10%

Behavioural Patterns, 40%

Genetic prediposition, 30%

Health care provision plays a small role in preventing premature death

The environment around us, our genetic inheritance, how we live our lives and the opportunities we have together

largely determine our health. International studies suggest healthcare contributes only about 10% to preventing

premature death, although this varies in different settings.

McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion.

Health Aff (Millwood) 2002;21(2):78-93

The wider determinants of health, including behaviour, have a greater influence

on health outcomes than genetics and healthcare combined

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Why social prescribing

• GP’s conscious that they were not always meeting the

wellbeing needs of their patients.

• Some VCSE organisations under utilised

• Increasing recognition in the role of the wider

determinants of health by the health community

• The CCG had a strong focus on prevention and self care

• A need to shift from a reactive, disease-focused

fragmented model of care towards one that is more

proactive, holistic and preventative

The Social Prescribing is a

key enabling project within

the CCG’s Prevention & Self

Care programme of work

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What is Social Prescribing

“A clear, coherent and collaborative process in

which healthcare practitioners work with patients

and service users to select and make referrals to

community based services.”

(Langford et al, 2013)

Pilot sites in Gloucestershire

Forest of Dean

South Cotswolds

Cheltenham

Stroud and Berkeley Vale

Gloucester City and South Tewkesbury

Tewkesbury – 3 town centre Practices

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Partners

The issues spectrum

Social isolation

Carers and caring

Respite

Mobility / Transport

Debt / rent & council tax arrears

Employment

Literacy

Food banks, gas & electricity

Poor mental health & wellbeing

Sensory disabilities

Benefits related

Lifestyle

Substance misuse

Lack of social skills

Domestic violence

Managing homes

Supporting / handholding

Learning disabilities

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Services, organisations and community

Support Grant for

carer's travel Age UK

Active and Able

Classes Social Groups

Citizens Advice

Bureau Memory Café RNIB Active Lifestyles

Information on

pension credit Memory Club

Information on Green

Gym Environmental Health

Information on Blue

Badge application Alzheimer's Society Singing Groups

Mears Safe at Home

service

Counselling Carers

Gloucestershire Crossroads Fairshares Timebank

Chiropodist Information on local

solicitors Information on local

hairdressers Hospital Transport

Respiratory Exercise

classes Befriender service Village Agents Netball Club

South Cotswolds

• 100% of respondents have seen

an increase in their WEMWBS.

• On average, scores increased by

21.9%.

0

5

10

15

20

25

30

35

40

45

Forest of Dean (n=11) South Cotswold (n=10)

Average Initial and Follow-up WEMWBS

InitialWEMWBS

Follow-upWEMWBS

Mental Health & Wellbeing

Warwick-Edinburgh Mental Wellbeing Score (WEMWBS) tests undertaken at referral and after 12 weeks.

The evaluation of social

prescribing in Rotherham

found a comparable figure of

83% of referrals (n =283)

seeing a positive increase.

Forest of Dean

• 72% of respondents have seen an

increase in their WEMWBS.

• On average, scores increased by

13.5%.

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Use of Primary Care

Data collected by participating practices on frequency of appointments 6 months before and after referral.

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Forest (n=34) S Cots (n=63)

Avg TotalAppnts. 6monthsbefore

Avg TotalAppnts. 6monthsafter

Average total appointments 6 months before referral and 6 months after.

Forest of Dean (n=34)

• 67.7% of patients have seen a reduction in their use of primary care.

• On average, in the 6 months after referral patients saw a 24% reduction in appointments

South Cotswold (n=63)

• 44 % of patients have seen a reduction in their use of primary care.

• On average, in the 6 months after referral patients saw a 9% reduction in appointments

An evaluation of a social prescribing project

in Bristol found that 60% of patients saw a

reduction in their use of primary care.

The evaluation of social prescribing in

Rotherham also found significant reductions

in use of hospital-based services.

“This has changed my life - because from having reduced confidence and not knowing who

to turn to, now I have this background support. It has made a huge difference to my life”

“It made my depression a little better”

“ I have people around me and by joining a walking group I have made new friends”

“You coming to see me gave me the best day in ages”

“It helps me to live a healthy active life”

“It was very easy to get in touch with the co-ordinator, who co-ordinated contact with the next person at the Independence Trust”

• 75% of patients spoken with felt that their social prescription had a positive impact on their emotional wellbeing

•50% of patients spoken with felt that their social prescription had a positive impact on their physical wellbeing

Interviews, questionnaires and collected case studies.

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She takes Cocodamol regularly, NSAID prn; PPI, docusate; low dose amitriptyline

eGFR drops her into CKD3, Ramipril added, then CCB.

A fall resulted in a Colles fracture; adcal and alendronate added

Loss of confidence with walking, can’t get out to walk her dog…SSRI

82 year old lady, widowed, family live 10

miles away, but with very busy lives

• Main problem: loneliness

• Main presenting complaint: low back and

leg pain

10 Medications…for loneliness

What does this mean for GPs?

• Surgery-based knowledgeable resource who can signpost to social

support

• Allows GPs to think and practise more holistically

• Takes pressure of GPs

• More healthy alliances formed

• Produces a system that is safer, more caring, more responsive,

more effective

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Social prescribing and

Prime Minister’s Challenge Fund

Scale up to cover all (82) GP Practices in the county –

629,000people.

Referrals from community hospital staff and staff in 21 Integrated

Community Teams.

Use of Prime Minister’s Challenge Fund to recruit social prescribing

hub coordinators.

Further evaluation.

Aligning social prescribing with Arts and Culture

Acknowledgements Create Gloucestershire and Joe Magee

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Background

• A 3-year programme supporting arts and cultural organisations to engage

in public sector commissioning and to create awareness amongst public

service commissioners of the potential for arts and culture to jointly deliver

their outcomes.

• Funded by Arts Council England and delivered by the National Council for

Voluntary Organisations (NCVO), in partnership with New Philanthropy

Capital (NPC), New Economics Foundation (NEF)

• Gloucestershire CCG is one of two national pilots with Kent County

Council being the other

• A local partnership between Gloucestershire CCG, CREATE

Gloucestershire, Forest of Dean District Council, Gloucester, City Council

and Tewkesbury Borough Council and supported by GCC, VCS Alliance

and the University of Gloucestershire

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National objectives

• Enable arts and cultural organisations to diversify and increase

their income streams by responding to public service strategic

commissioning opportunities.

• Create a greater understanding amongst public service

commissioners of the potential for arts and culture to deliver their

outcomes.

• Support policy development relating to strategic commissioning

so that it takes more account of arts and culture.

• Support an increase in audience or participant numbers for arts

and culture.

Cultural Commissioning Grant Programme

• Field of arts and culture for health and wellbeing in the UK is a

newly emerging specialism, and as such requires investment and

testing of approaches and models.

• £150,000 identified in the CCG’s 14/15 operational plan

• Seeking to understand how commissioning arts and culture may

have a positive impact on health & wellbeing outcomes

• Themes for the projects

a) raise awareness of certain health conditions

b) help people to develop strategies to manage specific aspects

of their health conditions

• Aligned with the needs of our local population

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Building on our clinical programmes approach

Grant projects

• Promoting healthy lifestyles in families

• Raising awareness of eye health through arts and culture

• Raising awareness of the early signs of dementia

• in the black, minority ethnic (BME) community

• Raising awareness of the importance of taking prescribed medication for diabetes with

teenagers

• Exploring how singing can benefit adults with long-term respiratory (breathing)

conditions

• Supporting young people to develop awareness & self-management strategies for good

mental health

• Exploring how arts and culture can support men who live with long term pain from

musculoskeletal conditions

• Exploring practical opportunities though arts & culture, to promote confidence and the

benefits of peer support for people with colorectal and prostate cancer

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SOCIAL PRESCRIBING IN GLOUCESTERSHIRE A mechanism for linking patients with non-medical sources of support in the community

REFERRAL BY HEALTH CARE PROFESSIONAL

(including GPs, PNs, ICTs, Community Hospital teams)

• Vulnerable and at risk groups e.g. low income, single mothers, recently bereaved older people

• People with chronic but stable physical illness; emotional stress

• Frequent attenders in primary care presenting with social isolation and other psychosocial and emotional

needs

HUB CO-ORDINATOR

• Personalised assessment/ care planning, co-production, behaviour change strategies

• Signposting/ information prescription or supported referral into appropriate group/ service

Welfare &

employment Arts & Culture

Environment &

horticulture Social groups

& support

Physical activity

& lifestyle

Employment,

benefits, housing,

debt, legal advice,

parenting support,

community

transport

Community choirs,

arts groups, drama

classes

Harp playing in NICU

Songwriting in

CAMHS units, singing

for stroke rehab

Universal/

low health

need

Singing for COPD and

mild/mod depression.

Arts on prescription

Gardening,

horticulture,

forestry,

bushcraft,

willowcraft,

woodcraft, green

gyms

Befriending

schemes, lunch

clubs, self

management/self

help groups,

memory café,

volunteering, time

banks, peer

advocacy

Health walks,

exercise classes,

healthy cooking,

Exercise on

prescription, weight

management

Respiratory exercise

classes, cardiac

exercise classes

Targeted

/moderate

health need

Specialist/

high health

need

Patient referred by hub co-ordinator Patient referred by health professional

A Stepped Model

Universal health & wellbeing needs

Mild to moderate needs and/or stable health conditions

Multiple & complex needs and/or potentially unstable health conditions

A continuum of

intervention to meet

a continuum of need

Small group singing co-

facilitated by vocal leader and

respiratory physio for unstable

COPD or asthma

Ballroom dance for frail

elderly in care homes for falls

prevention

Live harp music in a special

care baby unit to soothe

stressed babies and parents

Singing to increase lung

capacity in stable COPD or

asthma

Street dance for diabetic

teenagers to manage blood

glucose & salsa for adults

Yoga for low back pain

Creative writing to alleviate

mild depression

Walking for health; community

choirs for social isolation;

Zumba for weight management;

painting for relaxation; luncheon

clubs for friendship; debt advice

for stress

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Questions

Matt Pearce

Senior Commissioning Manager

Gloucestershire CCG

Matthew.pearce4@nhs.net

Helen Edwards

Local Implementation Manager

Gloucestershire CCG

Helen.edwards28@nhs.net