Social prescribing involves referring people to alternative non-clinical services to address their unmet needs. It was highlighted in the NHS Long Term Plan (NHS England, 2019a) as a key component of the Universal Personalised Care Model and identified as one of the NHS England's 10 High Impact Actions (NHS England, 2016). All GP practices will join one of the 1400 primary care networks in England by 2023/2024, and funding has been secured for employing a ‘link worker’ to support social prescribing in each network from 2019 onwards (The Pulse, 2019).
At present, most of the social prescribing referrals are completed by a GP; however, increasing numbers of health professionals including practice nurses, secondary care consultants, and allied health professionals (such as physiotherapists and pharmacists) are taking on the role of social prescriber (Dowden, 2019). Paramedics working in primary/urgent care services and ambulance clinicians working in traditional NHS ambulance services should consider how they can incorporate social prescribing into their clinical practice.
What is social prescribing?
Wider social determinants such as income, social class, occupation and parental occupation, level of education, housing condition, neighbourhood quality, geographic region, gender and ethnicity are well recognised factors that could significantly influence a person's health (Marmot, 2010; Bibby and Lovell, 2018). Combined with increases in life expectancy, prevalence of long-term conditions, and frailty in the UK population (Hiam et al, 2018; Public Health England, 2018), demand on the wider healthcare system is ever growing.
Social prescribing aims to support people with a wide range of social, emotional or practical needs and improve their wellbeing (King's Fund, 2017), through a range of services provided by the local voluntary, community and social enterprise (VCSE) sector organisations. Some examples include befriending schemes, voluntary work agencies, ‘green gyms’, social or lunch clubs, and nature conservation schemes (Brandling and House, 2009).
Most social prescribing schemes rely on local agencies to refer people to a link worker where people are given time to focus on ‘what matters to me’ and to take a holistic approach to a person's health and wellbeing (NHS England, 2019b). However, the referral mechanisms, activities offered, intensity and support provided may vary from one social prescribing scheme to another (Drinkwater et al, 2019).
Social prescribing has been around since health professionals have taken an interest in and actively tried to address their patients' social circumstances, even though it may not always have been known by this name. Many paramedics and ambulance clinicians may have already delivered a range of social interventions to address issues that impact patients' living conditions including simple interventions (such as changing a light bulb), active signposting to local services, and referral to the local authority social care team.
How does it differ from active signposting?
Active signposting is probably the most common deployed social intervention by paramedics and ambulance clinicians. It is where staff give ‘light touch’ information to patients (i.e. brief interventions) and signpost them to services, using local resource directories and knowledge. This is often linked to the existing ‘Right Care’ alternative care pathway campaigns within NHS ambulance services.
Active signposting works best for patients who are confident and skilled enough to find their own way to services after a brief intervention. In addition, it relies on clinicians having good local knowledge of what services are available in their community. However, this could be challenging for clinicians working in NHS ambulance services which cover a large geographical area. Furthermore, the rapidly-evolving landscape of VCSE organisations means it can be difficult for individuals to stay informed about available services or for organisations to maintain an up-to-date directory of services over time.
Social prescribing schemes use link workers to minimise these challenges. Following the identification of unmet social needs during initial clinical consultations, but where active signposting is deemed not to be appropriate (either through the lack of knowledge of the local services or patient/client inability to negotiate the system without assistance from a link worker), paramedics and ambulance clinicians could instead refer their patient to their local link workers who would explore the patient's social needs and guide them through the services available locally.
Which patient groups would benefit from social prescribing?
Drinkwater et al (2019) suggested that the target groups for social prescribing would be patients who may require a greater level of social and emotional support to improve wellbeing and health than is available in routine care.
Patients who might benefit from social prescribing include:
What does it mean to paramedics?
Paramedics and ambulance clinicians are urged to consider wider social determinants as part of their routine clinical practice. They can do this by ensuring a holistic approach to addressing patients' physical and psychosocial needs, in order to promote health and wellbeing. They should act as champions to promote the use of VCSE sector services to address patients' social needs.
Paramedics who are working in a primary care setting should be actively involved in the design and roll out of social prescribing in their local primary care networks. They should promote the unique knowledge and experiences of the paramedic profession and how they could be used for the social prescribing agenda.
Ambulance clinicians who work in the NHS ambulance services should liaise with the local primary care networks to explore how they could act as social prescribers and refer to link workers in their locality to ensure this valuable pathway can be fully used.