News and Comment

Social prescribing offers a model to prevent ill health, but shared decision making could be the mechanism that makes it happen

Thursday 12 December 2013

There is a growing acceptance in the medical community that people who lead happy and active social lives enjoy better health than those who do not.

Whilst medical interventions are of course necessary to treat specific conditions or health problems, the importance of strong social networks, access to friends, family and support, and an active social life should not be underestimated. Evidence shows for instance that people who have a strong network of social support means they are more likely to take prescribed medicines, and that exercise reduces the likelihood of people recovering from depression.

Such discoveries have led to a growing interest in what’s known as ‘social prescriptions.’ Social prescribing is defined as “a means of enabling primary care services to refer patients with social, emotional or practical needs to a range of local, non-clinical services, often provided by the voluntary and community sector.”  In practice this means that GPs, nurses or other healthcare practitioners work with patients to identify non-medical opportunities or interventions that will help them adopt healthier lifestyles or improve wider social aspects of their lives. The resulting services that patients can choose include everything from debt counselling, support groups and walking clubs, to community cooking classes and one-to-one coaching. Social prescriptions can be seen as a natural extension to ‘information prescriptions’ – which are tailored information given to patients to help them make informed choices about their care and access a wider range of services, such as social care, housing and leisure services.

The main goal of social prescribing is to promote better patient outcomes, whether that is reduced heart disease, better management of diabetes, or improved mental health. But importantly in this climate of reducing budgets and increasing demands in the NHS, they are also part of concerted efforts to reduce the number of referrals into the acute sector or uptake of more costly interventions. Small scale pilots of social prescribing have shown that the initiative leads to a more appropriate use of health care professionals’ time, and reduces unnecessary medical prescribing.

However, a recent survey of GPs conducted on behalf of Nesta showed that whilst 90 percent believe that patients would benefit from a social prescription, only 9 percent of the public said they have received one. The story of implementing change in the NHS shows that you need to use several policy levers and initiatives driving at the same goals to – in the jargon – achieve ‘policy alignment’. It is in this context that I think we should consider shared decision making (SDM). SDM is the conversation that happens between a patient and their health professional to reach a healthcare choice together, often by clinicians using decision aids that present evidence about different care options to guide conversations with patients. The Government is now committed to making SDM the norm across the NHS.

SDM could be another, important way to press home the case for social prescribing, by building in commitments within the tools and approaches that accompany shared decision making, to make social options more available to support patient’s health. In our evaluation of the MAGIC programme – a shared decision making programme funded by the Health Foundation, we found that clinicians understood the potential for shared decision making to promote better lifestyle choices, increased social support and better self-management of care. We observed that the deep conversations between clinicians and patients that typify SDM both encourage patients to think about how they can take better care of themselves, and to help people access a wider range of services and support. In practical terms, this might mean that decision aids – which are guides used by clinicians to help people make difficult decisions between different healthcare options – could be broadened in some cases to include information about social options to improve patient’s health and wellbeing.

In the long term it is possible to envision a scenario where the preventative benefits of SDM administered social prescribing are shared not only by those already experiencing serious long term conditions, but the population as a whole. After all there seems to be a number of drivers that are coalescing around the concept of patient self-care at the moment: internet based self-care; the building of community social networks; integrated care; information prescriptions and shared decision making. If social prescribing can be effectively incorporated into this thrust – and a genuine, joined-up approach implemented, the improvement to public health could be considerable.