British Lung Foundation
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Social Prescribing

I wonder if contributors and readers of this Forum are aware of the term Social Prescribing? It is a referral scheme in primary care designed to shift the focus pf patient prescriptions from illness to wellness. It is a relatively new approach to meet complex needs, including respiratory and chronic breathing conditions. Social Prescribing (SP) can help provide psychosocial support for people whose needs are not being met within existing primary care services or who may be using services inappropriately.

SP parallels the emergence of the fusion between health and social care and is part of that development. I suffer from bronchiectasis and therefore, like many of you, have a long term relationship with my GPs and with the NHS. This may be just what I am looking for if, for example, my doctor can be persuaded to write me a prescription, for example, to attend a gym or gain access to pulmonary rehabilitation. I would be interested if anyone else has experience of this type of GP prescribing and would like to share it here with the rest of us.

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Are the agencies that patients are sign posted to, voluntary groups or charities or state funded?

For example Age Concern and Luncheon Clubs, or BLF Breathe Easy groups which are mainly run by volunteers with charitable backing.

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You don't need a prescription to attend PR as you are referred. This is not a social need but a physical one. It might fulfil a social need too though. The same with a gym if you are overweight. My local doctor will do this but unfortunately unless you live very near or have your own transport the bus fares make it too expensive for many like me.

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Hi hyper at I agree with you about transport difficulties and cost. There have been previous posters here that mentioned it. I used to go to a private rehab scheme, but luckily I have a car and some of us would share lifts with those who didn't. However, if you lived out of the area , public transport was difficult if not impossible , especially for those with a health condition.

Also the classes were not free.

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No nor were mine but they were reduced. But after factoring in transport costs it wasn't really cheaper.

I do have a good gym a few minutes walk from me but they weren't part of the scheme. I asked them if they would take a doctors letter and give me a discount. They agreed but it would still have been £25 a month instead of £35 and I couldn't afford that. x

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Didn’t hear about it but it sounds useful, thank you.

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knitter. There is a mixture of agencies and services, including those which you example. Your local authority might have a Health Equity Strategy (or not) which places a focus on the community as well as statutory bodies such as the NHS and welfare agencies. In Dundee there are many dozens of sources that offer support in all three sectors of provision.

hypercat54. You are quite right that some services are available without a prescription as such, and I take your point about access costs. The nature of this referral scheme is defined by a focus of delivery that addresses structural and environmental issues, such as money and debt, employment and training, housing support and anti-social behaviour. The social care element means that link workers help patients gain access to social services directed at multiple deprivation communities. We constantly hear about the NHS, especially primary care, being overwhelmed by the sheer numbers of persons presenting for treatment. SP attempts to proportion supply to need. Not an easy task but this could be one way forward.

Terry.

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Social prescribing has been around for a while but I seriously doubt whether the NHS will carry on with it now it's under so much financial pressure. Which of course could well be a false economy but when it has so little money, it's hard to take the long view.

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I have been referred by respiratory nurse to a scheme called Starfish which provides emotional support. I have been to one Introduction session & it's free counselling with the emphasis on improving your social network i.e. Taking up new hobbies, charity work aswell as addressing your other stresses & problems.

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Great! Hope you're finding it helpful.

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Yes 02Trees, a good point and valid prognosis, although to some extent the preventative goals of this scheme allow for the merger of health and social care where the pressure is taken off the NHS in some respects and spread out beyond primary and secondary medicine. In the long term Social Prescribing helps relieve GPs of the stresses and strains of their practices (at least in theory), where too many patients present unnecessarily and could be treated psycho-socially by other agencies and services. This is part of the rationale of the fusion of the health and social care , although the crisis of under-funding of both halves of the equation is the valid point that you make.

It seems to me 8405Loi that your example bears out the main thrust of the SP scheme in that it helps to guide you to emotional support. It is very much an outreach, exploring different and innovatory ways of supporting patients, connecting them to alternative ways of handling care that is not necessarily pharmaceutical. It faces outward and away from the chronic cycle of medical dependency and can be a helpful source of support.

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I hope Im wrong Cateran.

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Our Care Commissioning Group is organising Self Care Champions, volunteers who can help surgery patients to find suitable self care solutions in their local community. It's still at the training stage for the champions, but they will have a local self care directory to help them suggest options for patients.

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That is good news Ergendl. It underlines the voluntarist aspect of much health support out there in the community, and parallels the statutory services and agencies of which the Care Commission is a vital part. Well done the Champions!

Terry.

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Hi Cateran , it's the voluntary aspect that concerns me.......the NHS relying on charitable contributions ?

Cameron's Big Society ?

The BLF, if you look at the 2012 list of charity contributions by donation, is way down the list behind heart , cancer and animal charities . Will some health conditions suffer from lack of money?

I agree that maybe there is a cycle of medical dependency for some patients....but the idea that some patients are considered to be presenting unnecessarily to a health professional worries me. Who is making the judgement and why?

I also agree that people should try and take more responsibility for their own health, but again in my opinion money is often a factor......for transport, for exercise classes....ok walking is free but you need a safe area to walk...internet availability to access mindfulness or meditation videos, or this BLF/ HU site.

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The points you make Knitter are spot on. Yes, Cameron's Big Society really didn't resonate, nor does it today what with other political distractions. And the roulette metaphor carries over into your listing of charities, with lesser perceived chronic health conditions like my own bronchiectasis way down the list. About the medical dependency argument: the current scenario with service cutbacks and austerity measures suggests that GPs are struggling, in some inner city practices (and rural pockets) overwhelmed with the numbers seeking constant help. A and E departments, the ambulance queues, seem to be a result of bottlenecks and waiting times at GP surgeries as well as hospitals flat out to provide cover and beds, etc.

I agree about the value judgements at play here. Who decides is rather taken out of the hands of medics and GPs, to become a matter of logistics rather than a moral evaluation. In the case of social prescribing, there are barriers becoming apparent where services too are overwhelmed with GPs referring too many patients to the psych-social areas of support. A case of passing the problem on to another source or service unprepared for SP, inflexible, not ready for the challenges of patients referred, service fragmentation, hidden waiting lists and referral cancellations.

It all smacks of desperation but at least it might be possible to address the moral question of rationing and who decides what by applying a form of proportionate universalism (sorry about the jargon), rather than any saturation strategy for patients referred. A form of equity rather than equality, rather like a staggered start in a track race. If competition for places is a likely outcome for social prescribing then it might be preferable to allocate access proportionate to the level of disadvantage, to need.

Terry.

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if we are not careful our nhs will end up like American health care.

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Good post Terry. I am inclined to agree with 02 and knitter. Patients will still have to be seen initially by their GP, and whilst in many cases relying on charitable organisation etc will ease pressure, it would concern me that there may not be feedback and some folks will fall through the net. Another huge worry is that Hunt has bagged himself an addition to his portfulio SOCIAL Aaargh! Now that is a worry.

cx

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I know what you mean about the Hunt reference but it has a kind of bureaucratic logic given that the merger is well under way (at least in Scotland). It seems to me that GPs may well have certain patients in mind for referral, ones who persistently present as candidates for Social Prescribing. I am not implying that there is a blacklist in some surgeries, although a majority of those patients who are referred have good reason to need the "prescription", particularly poor mental well being affected by social circumstances. Many GPs have the best of intentions in referring mild to moderate depressive patients with long term physical conditions and who are frequent attenders in primary care, as well as in hospital A and E departments. SP is intended to be a preventative measure with a strong psychosocial intent.

Terry.

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I see your point Terry and to some extent I think it is happening already. eg I have IBS and because of Crystal telling me about a prof in Manchester who has clinicians who have found hypnosis to have positive results, especially in women. His secretary sent me a 1,000 patient audit. I rang my CCG and found they do refer some patients from GI to hypnosis within my city. I still have to see them in GI. This sort of social/alternative prescription still has to be paid for but on the other hand there is no way a con could give you the amount of time given over to hypnosis. It won't be cheap as the hypnotherapists are or have been doctors, dentists or phychotherapists.

I believe they give leaflets out in most surgeries now for people to self refer for anxiety/depression talking or CBT therapies.

I imagine it is similar to medical care in general, in that it is probably a post code lottery.

It definitely has its place.

cx

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Social prescribing is a great idea in theory, but I haven't much time for the reality (see below.)

Part of the reason is that it is explained and justified by people who habitually use a great deal of impenetrable jargon. This has become typical NHS-speak, you see it all the time in the so-called public "consultations" concerning the NHS, in CCG documents etc. Call me cynical, but I sometimes suspect this is to be a deliberate tactic to prevent NHS service users from realising exactly what is going on. What better way to confuse and deter public involvement than by using 20 unfamiliar words when 2 plain ones would suffice?

My own experience of SP was when my GP recommended counselling, to help me deal with the anxiety associated with the strain of living with multiple health conditions. I received a letter saying I was being "signposted" to a "mental health hub" by a "health in mind facilitator" (I've still got the letter containing these amusing terms!) The facilitator duly telephoned and after a chat of no more than ten minutes she recommended I visit a library and borrow a self-help book, or buy a CD from Amazon. I can laugh about it now but during those desperate times I found such a fatuous response very upsetting.

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I couldn't agree more with what you write here Hanne62 though I wouldn't go so far as to say that NHS Speak is a "deliberate tactic", rather that the users of such inaccessible English are unaware of its impenetrable jargon, and yes, sometimes sheer gibberish. It is a particular means of communicating an educated elitist exchange that is at times projected on the wrong 'screen' so to speak, to a public that is outside the reception area and tuning in to a different, more populist programme or station. It is professional and bureaucratic language that does not gel with normal public discourse. Yet it serves its purpose within the closed world of medical and political communication. I would suggest that even our exchange here and now in this forum has its elitist style and vocabulary which we may not always be aware of using. We agree on one thing: that circumlocution is a barrier to patient advocacy, but then again, it rather depends on to whom we are speaking. We shift registers. We choose the vocabulary and sentence construction that fits, at that moment. i would not insult your intelligence Hanne by talking down to you, but pay you the compliment of a shared educational background obvious from your usage, which is cultivated and sophisticated.

I realise that I am defending NHS Speak. Has the institution "got to me"? Eek!

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