Celebrating social prescribing success in times of change
Anna Lodge, South West AHSN’s Communications Director, talks to key figures from the Institute for Social Prescribing test beds and hears their reflections on how far they have come together.
When the final meeting of the Institute for Social Prescribing took place this summer, it concluded a successful two-year project, and the close of the Institute.
The Institute was formed to work with a series of ‘test bed’ sites in the South West, with the aim of accelerating the spread and adoption of social prescribing best practice across the region. At that point, social prescribing had emerged as an effective response to health and care challenges that traditional approaches to medicine – namely ‘treatment and tablets’ – were struggling to tackle.
The idea behind social prescribing is that many factors – for example, debt, housing, environment and lifestyle – affect a person’s health and wellbeing. It advocates working with people to find solutions to health issues – this might involve linking them with practical, social and emotional support in the community (such as ‘stop-smoking’ groups or mental health charities) or perhaps starting a group themselves.
The Institute sought to harness the influence of social prescribing and learn from the outstanding work that was already being carried out by projects in the region. Using tried and tested methods from within the South West AHSN, the Institute sought to support practitioners to improve and spread their innovation. While the Institute was formed before the COVID-19 outbreak, its work proved invaluable during the pandemic.
Fast forwarding innovation in social prescribing
The Institute was hosted by the South West Academic Health Science Network (South West AHSN), with its President, Professor Sir Muir Gray, and its chair, Dr Michael Dixon, who is NHS England National Clinical Lead for social prescribing.
Dr Dixon explained what the project aimed to achieve and how it went about it: “The Social Prescribing Institute’s challenge from the beginning was to answer the question – ‘How do you fast forward innovation in social prescribing?’.
“Our answer, first of all, was to select some exceptional innovators in social prescribing and establish them as test bed sites for the Institute. The next task was to connect them all up to provide updates on national initiatives, and to share their own knowledge and experiences.
“As COVID-9 progressed, this was largely by virtual connection on a monthly basis. These meetings would become a ‘hot house’ for exchanging new ideas, successes and failures with every test bed site taking on some of the ideas provided by others with the whole ending up as far more than the sum of its parts.
“Each test bed site helped the others to up their game through a mix of companionship, support and possibly a tiny element of friendly competition.
“The result was an explosion of energy, commitment and achievement. But something else developed – something a bit ‘right brain’: mutual respect and friendship, which made the work ever more enjoyable and satisfying with the group of test bed sites determined to continue beyond the two-year life span of the Institute.”
The Institute worked with five test best sites selected based on strong track record or potential for impactful innovation – in Frome, Cullompton, St Austell, Kingsbridge, Ilfracombe and Cullompton. This involved examining each programme in action, detailing the history and local context as well as the approach and impact for people, communities, professionals and commissioners, with a focus on the response to COVID-19
The work culminated in an extensive insight report, which included case studies of the test-bed programmes and shared learning about the conditions needed for social prescribing to be successful. It also identified a set of eight commonalities that can be applied to accelerate the impact and spread of social prescribing programmes.
The five South West Social Prescribing test beds
In Cornwall, St Austell Healthcare, a general practice, worked rapidly to meet the needs of vulnerable people during the COVID-19 crisis. This involved signposting people to a support app and prioritising people most in need of help during the initial outbreak.
Dr Stewart Smith, who is a GP Partner at St Austell Healthcare and also PCN Clinical Director and Social Prescribing Lead, said: “I was most proud of the way that our team autonomously adapted to completely new challenges and new ways of working during the pandemic. They have worked harder and helped more people than ever.
“I’m particularly proud of the leadership of Hayley Burgoyne [St Austell Healthcare’s Head of Social Prescribing], who is a complete inspiration to everyone around her – be it patients, colleagues or volunteers. As well as fulfilling their normal roles, Hayley and team have helped deliver thousands of food parcels, medications and welfare checks on our most vulnerable patients throughout the pandemic.
“They have also recruited volunteers across our vaccination site and surgeries to help keep people safe and bring much-needed cheer and emotional support to our community throughout the pandemic. Our volunteers have been integral to delivering over 30,000 COVID-19 vaccinations.
“Our efforts during the pandemic were enhanced by the peer support and idea sharing with fellow test beds in the Institute for Social Prescribing. We have imported the community connector model from Frome and developed our young persons service with support from Cullompton. You’ll see numerous examples of sharing of ideas and support for one another leading to quality improvement and scaling of social prescribing to reach new groups across the test beds.
“We have continued to develop the help@hand app and have begun training community connectors to utilise the app to signpost friends and family to any support they may need. The pandemic has driven innovation and change rapidly. The culture of dynamic adaptation, autonomy under excellent leadership has allowed the team to rise to the challenges of the pandemic.”
In Kingsbridge, the work of South Hams Area Wellbeing (SHAW) work has focused on tackling the loneliness and isolation brought about through the pandemic.
A ‘community builder’, employed to complement the role of link workers, co-ordinated the delivery of a Wellbeing Programme in Sept 2020 on and around Slapton Ley Nature Reserve. The biggest advantage of this was that it was held outside, engaging in nature, and which ensured it adhered to COVID-guidance at the time. Link workers and GPs were able to refer individuals into this free 10-week programme. Following on from this success, sessions are now being held – and links formed – with the local secondary school to deliver wellbeing sessions to students at the Ley.
Securing funding from Active Devon, SHAW also offered free online exercise classes to those in the community, throughout March and April 2021. The purpose was to support individuals in moving more, and SHAW partnered with three local personal trainers to deliver these classes via Zoom. One participant commented: “It is such a great opportunity to kick yourself up the bum! I was really nervous and wanted to back out, so glad I never did, the group is so inclusive of all our different fitness levels. I’m glad I signed up – our Thursday group is lovely and supportive.”
The Joy app is currently being trialled in the area to make it easier to make referrals between GP and link workers. Key partner organisations in the community are also supporting the trial, advertising their services online, to which link workers can refer quickly and efficiently.
Frome’s social prescribing service is led by Health Connections Mendip, a team which is employed by the Mendip GP practices. Reflecting on its key successes, Jenny Hartnoll, Health Connections Mendip Service Lead, said: “We’re very proud of what we’ve been able to achieve by working alongside local communities, and our shared response to the challenge of COVID-19 particularly stands out.
“When people started shielding at the start of the first lockdown, GPs sent a letter out to those shielding, which gave government advice on what they should do if they develop symptoms. However, we were also able to add information about other support, such as links to the local community Covid response groups, befriending services, mental health support and food and medicine delivery – as well as Health Connections Mendip contact details for support and help if people needed.
“We were also able to call on the town’s informal network of active citizens to distribute a guide on health and wellbeing during Covid to every household in Mendip – a huge number – to help those who might have struggling during the lockdown.
“What we also do well is to link people in need of support to primary care and other services. For example, if a befriending organisation [a group that helps people suffering from loneliness] is concerned about someone they are supporting, but the person doesn’t have the confidence to reach out for help, the organisation can contact us, with the person’s permission, and we’re able to direct them to an appropriate service or professional.
“Another example of a simple initiative when people were not able to meet inside was when Health Connections Mendip set up a Talking Bench in outdoor areas of Mendip towns, where people were able to connect and be signposted to support if it was needed.
“In this period, we have seen issues and needed to implement solutions really quickly, hand in hand with the community. These have often been really simple, common-sense things to do. It has been amazing working alongside so many community initiatives which sprung up during the pandemic.”
Frome’s social prescribing work also hit the national headlines in 2018 when it was featured in a Guardian article.
In northern Devon, social prescribers are key members of ‘One Communities’ – place-based organisations that bring together residents, statutory organisations, businesses and the voluntary sector to tackle local issues using local knowledge and people.
Hannah McDonald, Partnership Development Manager for One Northern Devon, said: “By fully embedding social prescribers within this structure, they’re able to identify gaps and needs that can be brought to the One Community for development across the different sectors. Each One Community has a community developer who is funded through One Northern Devon and works as a team with the local social prescribers.
“In northern Devon, we have been using this model of community development supporting social prescribing for eight years. This model has been spread across northern Devon but has naturally evolved to meet the specific needs of each local community.
“We also have moved on to the next step of social prescribing which we call our ‘Flow’ project. Flow is fundamentally about wrapping support around the person who needs it – wherever that support comes from within the system. People aren’t referred on, but support is pulled to them. Social prescribing plays a vital part in this new way of working.”
During the COVID-19 pandemic, the social infrastructure and relationships built by One Northern Devon provided rapid community-led volunteer support for those affected by the virus.
“Over the past two years, we have been blown away by the voluntary support which has emerged within northern Devon,” said Hannah.
“Each of our seven One Communities developed a volunteer support system, so that our most vulnerable community members were able to stay at home. This support included shopping, neighbourly phone calls, picking up prescriptions and much more.
“Alongside the local district councils, we developed a cascade system where people could contact the council for support to isolate. They would send requests to the One Communities who had volunteers signed up to go and help. In some of the communities, volunteer co-ordinators for each street posted leaflets through doors to make sure no one was missed.”
Social prescribing for adults has been in place in Cullompton since 2007, but the service evolved to operate as part of a wider across the Culm Valley Primary Care Network.
In 2019 the GP practices realised that more needed to be done for children and young people in the town. They led the development of a Youth Forum, bringing together young people with other local agencies and charities.
The COVID-19 outbreak in March 2020 forced all face-to-face complementary and volunteer-led activity for older people to cease. Practice-based link worker Ruth Tucker worked with local voluntary sector organisation, Involve, to support the community response to the virus. Ruth contacted over 500 shielding patients to offer additional support to manage their health and wellbeing, including the delivery of prescription medication and food, and opportunities for social contact.
The programme has continued to develop through the efforts of Dr Daisy Robinson, a GP Partner at College Surgery Partnership in Cullompton and Social Prescribing Lead for the Culm Valley.
Dr Robinson has worked to adopt a more co-ordinated approach for adult social prescribing and has also seen how the programme has benefitted from working with the Institute: “Being able to join the Institute [for Social Prescribing], and learn from others trying to similar things, has helped us to move forward at a much faster pace than if we were going it alone,” she said.
Today, Cullompton it’s not only providing social prescribing for adults but also has two extra social prescribing link workers for young adults and children. And the service will be developed further in September, when it introduces social prescribing to the local secondary school.
Looking ahead – improving health equity through innovation
The Institute for Social Prescribing was, truly, an outstanding example of partnership working and collaboration, and Dan Lyus, South West AHSN’s Partnerships Director, paid tribute to all who played a part: “We’d like to thank Dr Dixon, and everyone involved in the social prescribing test beds, for embracing this hugely productive endeavour.
“Their hard work, support and enthusiasm have been essential in helping share and spread the learning and insights from these programmes, as well as providing invaluable support during the COVID-19 pandemic.
“The South West AHSN is honoured to have been involved in this work and hope our insight report will provide essential reading for other individuals and groups involved in the delivery social prescribing projects.”
So, what’s next for the South West AHSN and social prescribing? Well, we’re building on the insight and experience gained from this work to deliver our work focused on health equity. We aim to improve health equity by narrowing gaps in access to care, quality of health and care services, opportunities for a healthy life and individual agency in managing personal health and wellbeing.
And, in delivering our work improving health equity through innovation, we are seeking maintain relationships with the Institute’s test beds and the members of its research and learning group, with a view to involving them in relevant social prescribing work as it evolves.
As it comes to the end of its journey, we believe the Institute can reflect on a hugely successful two years – as Dr Dixon sums up: “The Social Prescribing Institute has shown that much can be achieved with a minimum of meetings and by maximising the imagination and commitment of those working on the frontline.
“In this way the Institute has not only shown a future path for social prescribing but also a modus operandi for turbo-charging improvement and spreading innovation.”
Read more on the South West AHSN website about the Institute for Social Prescribing and download a report, including case studies on each of the test bed sites, published in 2021.