Dr Patrick Hutt(Queensbridge Group Practice)

City and Hackney Social Prescribing GP Lead

Social Prescribing

Overview

• Background• What’s been happening in Hackney?• Consortia Pilots• I-Care• Social Mapping Exercise• Evaluation

London

The Inverse Care Law

“The availability of good medical care tends to vary inversely with the need for it in the population served….”

Tudor Hart, Lancet 1971

Wealth of Epidemiological Data

Black Report 1980

Acheson Report 1998

Marmot Review 2010QuickTime™ and a

TIFF (LZW) decompressorare needed to see this picture.

Poverty of progress?

All reports similar findings & advocate similar actions:• Early Years/Childhood• Education, Training, Jobs• Housing• Cross –governmental action

Bambra C et al. A labour of Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review. JECH, 2010

What is the role of General Practice?

The Deep End

‘Single woman in her 30s asked to do work of several staff at supermarket due to cutbacks. Can’t cope, stressed, makes looking after three teenage school kids with behavioural problems harder. Attends emergency surgery crying +++. Doesn’t know who to turn to so comes to GP. Long, unscheduled, consultation.’Deep End, 2012

Tackling Health Inequalities: Strengths of UK General Practice

• Generalist Approach• GPs at the heart of the community• Strong tradition of GPs seeking

social change to improve health• IT system that allows population

data to be linked to consultations

Kings Fund (2010)

Centre Of The Community

• GPs know their population• Well placed to sign post patients• GPs are aware of local organisations• GPs are trusted• Able to work together with community groups

to tackle local issues

Picture Quiz

Challenges To This Idea

• GPs don’t know their local population• Community and Voluntary Organisations find

GPs unapproachable, ‘too busy’• Rapid Turnover of Projects• Directories are not up to date• Clinical pathways don’t utilise the potential of

local organisations • ? Hard to re-create Bromley by Bow

GPs facilitating better linking between patients and community organisations

Social Prescribing City and Hackney CCG

Positive Benefits• Reduction in symptoms (anxiety and

depression)• Social Benefits (inclusion, participation, access

to new networks)• Practical and material Benefits (debt, housing,

benefits)• Skills (employment)• Quality of Life (reducing isolation, loneliness,

lack of confidence and self esteem)Friedli et al, 2009

Comments from Dundee

• ‘I think so yeah [recommending the scheme], if they were sort of in a rut and that, aye…’ (patient)

• ‘Some patients say they are simply not v good at speaking. I say: ‘this isn’t traditional counselling – simply looking at where you are now, what things are out there that would sit well with your interests to compliment your life.’ (GP)

Friedli et al Sept 2012, Dundee

City and Hackney CCG Project Aims

• to enable individuals feel more in control, have improved self-esteem and confidence, and self-report an improvement in health and well-being

• to reduce social exclusion• GPs and their teams become more aware of what’s

happening in the community and vice versa• to support individuals to visit the GP or hospital less as

they are managing /coping better• to improve sense of community well-being – mutual

support

Pilot project timetable :

Phase 1

Planning and development

(key stakeholder engagement and multi-

agency project steering and task groups)

March -September 2013 1. GP Consortia

identified2. Service model agreed

3.Service provider agreed

Phase 2

MobilisationOctober 2013- December

20131. External evaluation

provider to be identified2. Community mapping

completed3. GP Consortia and

providers agree referral model and publicity

Phase 3

“Going live”

January 2014 - March 2015

1. Patients referred to social prescribing

project2. Service monitored and

evaluated

Pilot project model• GP practices in the 3 consortia test sites will:• Refer patients to a local community activity s/he is aware of and also give patients the

option of a referral to a social prescribing co-ordinator for a full assessment and social prescription (using LBH I-Care Well-being Plan).

• The patient will also receive a social prescribing (telephone follow- up) with GP practice and a final report from the social prescribing co-ordinator.

Feedback from co-ordinator to GP – 8weeks

Children’s Centres

GP practices

Icare and a local service direct referral e.g. lunch club e.g. tea dances

social prescribing co-ordinator(s)

e.g. Befriending service

Three Pilot Consortia

• Rainbow and Sunshine Consortium• South West Consortium • Well Consortium

Hackney and City CCG Target Groups

• socially isolated/withdrawing• presenting with a social problem• struggling/not coping, but do not require crisis

intervention ( may have noticed an increase in GP visits)

• asking for “low-level” non-clinical activities to help them feel better

• Diabetics/Isolated Elderly Population

I – Care Website

www.hackneyicare.org.uk

Evaluation

• Important that we gather evidence • Academic tender underway• Please participate where possible• Survey in circulation – please ask colleagues to

complete also

Summary

• Social prescribing is coming to a consortia near you!

• All practices have access to ICARE – please encourage others to use (it can help!)

• Evaluation will be underway• Comments, questions, or suggestions – please

email sandracater@nhs.net

“Give me a place to stand on, and I will move the world”

Mechanics Magazine, Knight and Lacy, 1824

A GP is a Team Player

Primary Care – Now More Than Ever!

Improving Health Is A Team Effort

Thank you for listening!

Comments/Questions