Just what the doctor ordered! Prescriptions that don’t involve drugs
GPs can now refer patients with some common health problems for help and support while easing pressure on struggling NHS
WHEN Julie first contacted her GP for help, she was struggling with day-to-day life. A battle with anxiety had left her with no confidence and barely able to leave the house.
Rather than prescribe her antidepressants, Julie’s GP referred her to a community support worker who saw her on a one-to-one basis.
This ‘social prescribing’ scheme saw the link worker take Julie to weekly counselling appointments then, as she started to feel better, they suggested joining a cycling club then jogging sessions. Now, Julie is a jog leader at her group, encouraging those who are new to the sport.
‘Julie states that 18 months ago, she didn’t know if she could go on much longer,’ her link worker says. ‘Although she does still have hard days, she has now taken control of her own mental health and wellbeing and is living life to the full.
‘She loves being out and about at the various different groups that she attends and, in the future, hopes to be able to support other individuals who are experiencing a difficult time and show them they too can come through the other side of it.’
Julie was referred to a link worker programme run by Alliance Scotland, which has 61 case workers at 69 GP surgeries in Glasgow and West Dunbartonshire.
She is one of thousands of Scots who have benefited from social prescribing, an alternative to medicine. Patients are given specialist support to help them gain confidence and improve their lives, starting with small steps.
It is a deliberate step away from traditional medical prescribing, although patients may already be on drugs such as antidepressants as well.
Instead of giving out pills, it is now recognised that giving patients a ‘prescription’ for structured physical activity, support or therapy overseen by a link worker can make a huge difference to their life.
Around 16 per cent of Scots are estimated to have common mental health problems including anxiety and depression. Patients can be referred for social prescribing if their GP has access to the scheme and decides they would benefit. But with only 300 link workers in Scotland, experts want to see an expansion.
Amid overwhelming pressure on GP practices and shortages of doctors, those behind the social prescribing movement say Scotland could become a leader in the field, but warn it needs a huge push in order to be able to do so.
Social prescribing, also known as community referral, is used by GPs and nurses to support people who are struggling with a wide range of problems including mental health issues, isolation, and long-term physical health problems.
There are no restrictions on who can be referred.
PATIENTS who might benefit are given a link worker who supports them over several sessions to connect with local activities, services and events in order to improve their life circumstances, confidence and health.
Anyone with a long-term medical or mental health condition or experiencing loneliness, who is interested in the potential benefits of the scheme, can ask their local GP practice – but not all surgeries take part in it.
One of the main social prescribing aims is to help people become more active, which can range from a link worker joining someone on a walk to get them out of the house, to community gardening, lunch clubs and sports activities at local leisure centres.
Other activities could include joining a diabetes support group, spending more time in nature or joining a walking group, with the idea that these simple steps can enhance someone’s mental and physical health. More extreme sports such as wild swimming and mountaineering are being investigated for their potential benefits.
Social prescribing aims to reduce the number of patients making unnecessary appointments with their GP, ultimately taking pressure off NHS services.
It looks at the whole person in order to understand that there may be problems affecting someone’s wellbeing that are not always medical. These schemes exist in some areas of Scotland but availability can vary.
Now experts are calling for an overhaul of the system, with an urgent need to step up physical activity prescribing amid a ‘health emergency’. Movement for Health, a group of charities, recently held a conference aimed at understanding the importance of supporting people to start being active through social prescribing.
It revealed the findings in a new paper highlighting the need to transfer services away from the NHS and into the community to ‘demedicalise’ them.
It calls for services to be properly signposted, funded and resourced so that more Scots can benefit from them.
It wants better recognition of the role of link workers as they work directly with people, often helping them as they take their first steps on a social prescribing programme, such as getting out of the house for the first time in a long while.
Demedicalising the scheme would mean that as well as GP practices, other community workers could refer people.
THE report concludes: ‘The debate around social prescribing of physical activity will continue to develop. The Scottish Government and the main actors need to show leadership to continue this debate and to start to formulate policy responses that can help deliver real change for communities and individuals across Scotland.’
Dr Emma Lunan, chairman of Movement for Health, said: ‘Scotland has a health emergency and our approach needs to change.
‘A social prescribing postcode lottery exists – and it often comes down to the strength of the links between health services and the surrounding community.
‘Physical activity has huge benefits that go deeper than just physical and mental health. Proactive interventions can help individuals reconnect with their community and grow in confidence but many experience barriers when taking the first step so we need to work to overcome these.’
Clare Cook, project manager at Spring Social Prescribing, which runs projects across Scotland and Northern Ireland, said: ‘Often a little hand holding in order to build a person’s confidence or provide some reassurance along with good local knowledge goes a long way. Social prescribing presents a host of benefits to individuals, communities, healthcare and government.’
Whilst there is not yet any centrally held data on the prevalence and outcomes of social prescribing programmes, organisations running the schemes report individual success stories.
Alliance Scotland describes one client who was referred to a walking group then to a local allotment project. Now they are volunteering, which they say has helped increase their confidence and mental health.
‘They do not require GP appointments as often as they did before engagement with the walking group or allotment project but still feel supported,’ it says.
Other examples include a teenager who was due to leave school but whose mother was worried she would struggle without the school social connections, as she had a history of panic attacks and an eating disorder.
She was given a free gym pass and a place as a volunteer which made her feel more confident about starting a college course.
A Scottish Government spokesman says it is committed to increasing social prescribing across the country.
But there are concerns about where the money will come from, given the massive constraints on
the health budget. The Movement for Health report warns: ‘The NHS is not currently giving sufficient financial support for interventions they refer on to in the community.
‘There is therefore a need for a cultural change, as well as a re-examination of where and how money is spent.
‘Without longer term, sustained funding the benefits of prescribing movement may not be fully realised.’
A Scottish Government spokesman said: ‘We are committed to increasing social prescribing across Scotland. It’s an important holistic approach that empowers individuals to take control over their health and wellbeing. It can reduce isolation and increase resilience and confidence, giving an increased sense of purpose and belonging.’
But Sara Redmond, chief officer for Alliance Scotland, believes the situation will not be truly fair until every patient can access the scheme.
‘Social prescribing helps people to access the support available in their local community, bringing them renewed opportunities,’ she said.
‘The alliance community links practitioners provide non-medical support with personal, social, emotional and financial issues that support people to live well in their communities.
‘We hope in the future a community link worker will be attached to every GP.’