‘Social prescription’: the end of the beginning

Matt Jameson Evans

Dr Matt Jameson Evans, Chief Medical Officer and co founder of HealthUnlocked

The idea of working across organisational boundaries in the interest of patients is embodied within the NHS constitution. The voluntary and community sector provides a vast network of support that clinicians have the opportunity to signpost patients to. Yet boundaries between the voluntary and health services mean that this opportunity is rarely obvious. Social prescribing is a new concept in health focused on removing these boundaries and normalising non-medical support into medical pathways. Out of an idea has come a model that is ready to scale across the country.

From rhetoric to reality was the title to the recent King’s Fund event on social prescribing. And what an event… passerbys stared at a huge volume of people overflowing from the conference theatre into video spill-out rooms, with more than 400 people at an event originally intended for 200. This was not a typical King’s Fund event; there was a distinct hint of a social movement being launched.

With an ever-brighter spotlight shining on social prescription from NHS leadership, this event was the first ever dissection of the concept on a high profile national stage. And as with any situation where isolated individuals join a community of interest for the first time there was a sense of empowerment and excitement from the act of joining together. There was even something of a royal seal of approval with the Prince of Wales joining proceedings. Sam Everington, whose Bromley-By-Bow centre has laid the foundations to social prescription, described it to me as a ‘before and after’ moment in terms of public consciousness.

Advocates of social prescription are a highly motivated group of people – the ‘first followers’ of a movement in health. But what are the main realities we need to confront taking this forward beyond this group and into mainstream workforce?

Reality 1: A common language

Supported self-care, the output of social prescription, means different things to different people, stakeholders and commissioners. When is a care navigator a health champion, or a community volunteer, or a social prescriber? Even the term ‘social prescription’ resonates very differently: in a small-scale survey we conducted in 28 practices in North East London the term ‘social prescription’ ranked bottom in describing the activity of signposting self care services (after self-management support, holistic support, voluntary sector support). The need for a common lexicon that is recognised by all is clear. The crowdsourced Social Prescribing wiki from Healthy London Partnership is one step towards getting people on the same page. And just as with a Wikipedia page anyone with knowledge and expertise in the field is invited to edit it.

Reality 2: The need for scaleability and sustainability

We need to distill the success of discrete, face-to-face projects across into the large populations of the STP footprints. And it needs to be financially viable at scale. This involves sharing data, business cases, successes and failures into the mainstream. The key will be creating a jargon-free blueprint that makes sense to everyone from community volunteers to finance officers, and that can be implemented easily across the UK. It has to be a no-brainer to ‘go viral’.  

Reality 3: The power of evidence

A key to virality will also be the availability of evidence about social prescribing. The toolkit and evidence summary described by Marie Polley and launching in June 2017 will set the foundations for this but the onus on all those involved in social prescription will be to create data that can convince sceptics, not devotees.

Reality 4: The role of technology

This movement is about the power of people and communities, not gadgets. Alongside this comes the reality that digital, although not universal, is ubiquitous. A social prescription digital strategy bolted on as afterthought is destined to fail. Solving the problem of directories of services being system-reliant and constantly out of date is key. Enabling navigators, champions and volunteers with tools is also central. Above all, this will be about avoiding the life-sapping screenburn of a new system to learn and tech that follows communities, not the other way round.

What next?

The future of social prescription looks bright and the coming 12 months will be something of an acid test. If it can learn how to scale and coalesce it has the opportunity to emerge quickly as a mainstream tool in the new landscape of population health and place-based care. The key will be how rapidly it can articulate its value and transform a social movement into an evidence-based necessity that is scaleable across mainstream healthcare. Crossing from rhetoric to reality will be about crossing the chasm from early adoption into the majority.