“Social prescribing” (sometimes called “care navigation” or “care co-ordination”) is a bit of a buzz topic at the moment. Although similar approaches have been used for many years, the financial squeeze on clinical services is greater than ever, leading to greater interest in alternative pathways.
Social prescribing refers to the idea of GPs and other primary care professionals referring people to a range of local, non-clinical services, and treating people in a more holistic way; looking at the “whole person” and taking into account social, economic and environmental factors.
But does it work? Our experience running the Pregnancy Outreach Workers Service, Health Trainers and Gateway Healthy Futures, tells us that the answer is a resounding “yes”… but that creating a successful service depends on a number of factors.
Saving time and money… building resilience
Gateway Healthy Futures, a pilot programme that finished at the end of September 2016, was designed specifically to reduce the number of unnecessary GP visits by providing patients with a non-clinical alternative. GPs referred patients who had presented with risks including social isolation, low reported wellbeing, ongoing mental health conditions, alcohol or substance misuse, and financial hardship, and the Healthy Futures Practice Navigators provided them with practical support, reassurance and a point of contact.
It’s an idea that we had been batting around for a couple of years before we had the opportunity to develop it. Eventually, it came to fruition thanks to My Healthcare, a consortium of GPs in South Birmingham. Gateway Healthy Futures was one of a series of projects funded by MyHealthcare with money provided by the Prime Minister’s Challenge Fund.
It’s now five months since the Gateway Healthy Futures service ended, but we’re pleased to see initial reports from its formal evaluation (which was carried out by international development consultancy Mott Macdonald) are very positive. It shows that Gateway Healthy Futures reduced the time people spent with their GP (when a social intervention was more appropriate), and that the people our Practice Navigators worked with significantly increased their self-reliance and self-care during and after the support.
“…GPs are happy with the service because it is reducing the burden of social needs patients on primary care.”
“Feedback from patients … indicates that self-resilience levels have increased due to the scheme. Anecdotally, there is evidence of behaviour change; the scheme has helped some patients to understand that the GP is not always the most appropriate source of support for helping with non-clinical issues.”
The Gateway Healthy Futures service was also found to be cost-effective.
“The use of non-clinical staff members instead of GPs is cheaper by around one third of the cost.”
“… had [Gateway] not intervened, patients would likely have been referred on to social services at a much greater additional cost; the care navigation service is estimated to represent a saving in this scenario of approximately £10 per hour.”
Lessons for the future
One element that was key to the success of Gateway Healthy Futures was being able to work with GPs who engaged with the service. Because we already had a relationship with MyHealthcare (via Health Trainers) and the GPs had been involved with Gateway Healthy Futures from the start, they had confidence that it would work. This benefited everyone involved – including the patients, who trusted their GP’s recommendation and were more likely to engage themselves.
And thanks to experience gained from our other services, in particular from over a decade of running the Pregnancy Outreach Workers Service, we were also able to employ and train the right kind of staff. Our Practice Navigators provided a flexible, understanding and open-minded service, providing “whole person” support.
Rather than falling into the trap of “doing what’s best” for patients, without really consulting with them on a deeper level, Gateway’s services generally let the patient lead the support. We believe that asking someone what their priorities are, believing them, and working with them to build self-confidence and resilience creates a programme of support that is more successful and more sustainable.