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Impact Report: Year One 2016 - 17
A Social Prescribing Promotion project
Introduction
It is widely understood that social, economic and environmental factors have a significant influence on the health and wellbeing of people in Scotland. Social Prescribing, which aims to strengthen access to socio-economic solutions to health problems, is a valuable complement to other developments within health and social care. In March 2016, Carr Gomm was awarded the NHS Highland Health Improvement tender for a Social Prescribing Promotion Service to run for two years across Argyll and Bute. This Project name is now Connections for Well Being.
Connections for Well Being’s work is overseen by the Social Prescribing Steering Group as well as quarterly Contracts Meetings, which involve representatives of organisations from across Argyll and Bute: NHS Highland (which includes Health Improvement, Technology Enabled Care (TEC)/Living It Up (LIU), Contracts & Procurement, and Mental Health Departments); Mid Argyll Health & Well Being Network; Third Sector Interface and the Citizen’s Advice Bureau.
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Aims and Objectives: Progress
The key aims and objectives of the Promotion Service at the point of tendering were several.
Mapping out where Social Prescribing is already taking place in Argyll and Bute and develop case studies of good practice.
The part time Project Manager, Amanda Grehan, and members of the Project team including Carr Gomm management, have met with projects and professionals across the Argyll and Bute area to identify examples of good practice and to secure partners to develop case studies. A graphic design company has been approached with a remit of developing visual representation of these (see Figure 1, right, for sample template).
Figure 1: Proposed Case Study design
Raising awareness of the concept of Social Prescribing with the public, prescribers and wider partners, with an interest in improving health outcomes for people.
The Project Manager has networked extensively to work towards this objective (see map on page 6 of the report for more detail). In conjunction with the project Steering Group, the Connections for Well Being marketing plan has been developed with milestones for marketing materials to be produced and distributed throughout Year Two of the Project (see leaflet template below, Figure 2). These materials will be widely distributed, including through community and NHS staff communication channels to build on the groundwork achieved in Year One.
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Figure 2: Proposed Flyer branding (stock images to be amended for actual production)
Developing pathways to enable prescribers to easily navigate Social Prescribing; the ultimate aim of these pathways is to be the referral of people to social support services in their local communities.
The main achievement in this area of work has been the securing of two Link Worker pilot projects to run in Year 2 of the Connections for Well Being project. The workers (both part-time, one in Dunoon and one in Rothesay) have been recruited and are starting in role at the point that this report is being produced; as with all of the Connections for Well Being work. These pilot projects will be operationally managed through Carr Gomm; the work will be overseen by the Steering Group and funders (see page 5 for more detail on the Link Worker pilots).
Asset Mapping
There has been considerable local investment in the asset mapping approach, in particularly with reference to online resources. To develop this area of work, the Project Manager has liaised with staff across the range of resources available, including Elaine Booth, TEC/LIU Technology Enabled Care (TEC)/Living It Up
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Community Engagement Officer and Connections for Well Being Steering Group member; Gillian McInnes, Citizen’s Advice Bureau (CAB) Manager and Argyll & Bute Advice Network (ABAN) Chair, who is also a Steering Group member, and with several staff from the Third Sector Interface about their database, MILO (the Third Sector Interface is also represented on the Project’s Steering Group).
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The Link Worker Approach
Through the course of the first year of the Connections for Well Being project, funding has been found from two NHS Highland sources to enable us to develop and establish two pilot sites for the Link Worker approach to social prescribing in Argyll, one being the Taylor-Kavanagh practice in Dunoon and the other being the Bute Practice in Rothesay. Both workers will work with the practices for up to a year, depending on demand.
Their role will be to take referrals from GPs and other practice staff to link people in with non-clinical sources of support or resources within the community which can assist them to support their health and well-being. A wide range of activities might be utilised, depending on the person’s priorities and interests, from exploring opportunities for arts and creativity through physical activity to self-help, such as learning new skills. Depending on the individual’s needs, it might also be useful to link them in with agencies for direct assistance, for example, around employment or benefit advice or issues like drug and alcohol problems.
A Link Worker approach to social prescribing is part of a growing emphasis on community engagement activities, to develop a wider range of responses to health and social problems and to ensure that people have access to more information about available services and community projects. To date, schemes utilising a Link Worker approach have focused on deprived urban areas; Carr Gomm is therefore very pleased to be working with NHS highland to pilot this approach in more rural areas as part of the Connections for Well Being project. Learning from the pilot projects will feed into NHS Highland’s approach to social prescribing in the future.
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Engagement Activities
The Project Manager has talked with and met a wide range of professionals and groupings over the first year of project activity. Examples include:
All GP practice across Argyll and Bute have been contacted to promote the project, resulting in 11 meetings to date
All Health and Well Being networks contacted resulting in meetings with Islay, OLI and MAKI presentations (several meetings attended in MAKI during initial project start-up stage)
Questionnaires returned 87 meetings with providers of social
prescribing services and health staff including a Health Development Day (Inveraray) and Social Prescribing focus day (Lochgilphead)
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Informing all aspects of project development has been research including sourcing information and data on existing social prescribing services/projects.
Learning Points
There are a number of key learning points which have emerged during Year One of the project.
Differing opinions towards social prescribing have been identified amongst GPs across Argyll & Bute localities; for example, it was queried whether referring on to community resources was part of the GP role.
Numerous barriers to GPs, and other practice staff, socially prescribing, including:
Time constraints due to limited appointment times, and exacerbated by lengthy and time consuming referral forms, including writing correspondence in order to access a variety of supports (e.g. for Department of Work & Pensions/local authority departments etc.)
Lack of knowledge about what community support is available and/or about online information resources such as ALISS
The community sector was described as ‘confusing’; for example, short term funding leads to changes of services and activities, which makes it difficult for practice staff to keep up-to-date with what is available
Concerns from GPs and NHS staff about referring to the third and community sectors, for example, confidence about the quality of service
NHS IT firewalls which prevent outside referrals systems from being accessed.
Linking to a lack of knowledge, it was noted that some GPs do not live in the communities they serve. It was suggested by some that GPs and practice staff who do live locally may be better informed about local activity and be able to undertake social prescribing directly.
GPs and practice staff reported typically checking with each other when they wish to find out more information about what is available locally, although
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there were some references to utilising other resources, e.g. libraries and community notice boards.
A lack of effective communication channels was reported as existing between NHS departments, and between health professionals and social care organisations.
While third sector and community groups would welcome social prescribing referrals, it would prove challenging in terms of funding and staffing, should there be a sudden and dramatic increase in the need for support from some providers.
Local third sector organisations and providers network with each other and there is evidence of cohesive partnership working.
Third sector and community organisations report making referrals to each other in all localities.
A lack of awareness among some NHS staff about the standards and Codes of Conduct that third sector and community organisations must meet; e.g. a query from a GP about whether such organisations would have sufficient data protection protocols.
Certain Community Councils (CCs) have expressed that they do socially prescribe, but there were no case examples sourced to date to confirm this. CC’s have informed that they do this on an informal basis, to be of use to their community, but would not see this as an expectation of their role if social prescribing was to be a more formal procedure.
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Final Impact Report: 2016 - 18
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A Social Prescribing Promotion project
Introduction
Appreciation of the effects of social, economic and environmental factors on health and wellbeing of people is influencing the policy and practice environments in Scotland. Social Prescribing as a term covers a range of intitiaves which aim to address the wider range of determinants which affect health, to support self-management of individual health and wellbeing. In March 2016, Carr Gomm was awarded the NHS Highland Health Improvement tender for a Social Prescribing Promotion Service to run for two years across Argyll and Bute The funding enabled Carr Gomm to employ a half time Project Manager – this project’s branding was decided to be Connections for Well Being.
As well as ongoing direct contacts with NHS Highland, including quarterly Contracts meetings, Connections for Well Being’s work was informed by the Social Prescribing Steering Group which involves organisations from across Argyll and Bute.
In the second year of project operation, Connections for Well Being (CfWB) was awarded funding from NHS Highland to run a one year pilot of the Link Work approach to social prescribing in a rural area; the Argyll Street Practice in Dunoon agreed to be the GP partner practice in the pilot. The Bute Practice also agreed to include a one year pilot of the Link Work approach to social prescribing as part of its Transforming Primary Care initiative to improve Practice access for patients, so the pilot ran in 2 sites in 2017 - 18
This final project report therefore covers both strands of project activity - original generic social prescribing promotion project, and managing the pilots of the Link working approach to social prescribing in 2 Argyll & Bute GP Practices.
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Aims and Objectives
Year 1
The original key aims and objectives of the Promotion Service, which became CfWB, at the point of tendering were several:
Mapping out where Social Prescribing is already taking place in Argyll and Bute and developing case studies of good practice.
Raising awareness of the concept of Social Prescribing with the public, prescribers and wider partners, with an interest in improving health outcomes for people.
Developing pathways to enable prescribers to easily navigate Social Prescribing; the ultimate aim of these pathways is to be the referral of people to social support services in their local communities
Asset Mapping
An annual Impact Report was produced at the end of Year 1 – attached as Appendix 1.
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Year 1 summary
The Project Manager met a wide range of professionals and groupings throughout Argyll & Bute over the first year of project activity. Examples include:
In total, there were 87 meetings with health staff, social work and third sector staff as well as providers of social prescribing services including a Health Development Day (Inveraray) and Social Prescribing Focus Day (Lochgilphead)There were a number of learning points which emerged during Year 1 of the CfWB project which can be seen in Appendix 1.
Year 2 summaryKey learning points from Year 1 informed changes in the ambitions of the social prescribing promotion element of the CfWB project in Year 2: Differing opinions towards social prescribing were identified amongst GPs
across Argyll & Bute localities; for example, it was queried whether referring on to community resources was part of the GP role
Numerous barriers were suggested that were perceived as preventing GPs, and other practice staff, socially prescribing
Knowledge of what was available varied: some Practice staff noted the third and community sectors could seem transient due to short term funding
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It was suggested by some respondents that in Argyll and Bute, many GPs and practice staff live locally and so may be better informed about local activity and be able to undertake social prescribing directly.
Key performance Indicators for Year 2
In the second year of the CfWB project, given the introduction of the management of the Link Worker pilots, there was a negotiated change to CfWB’s Key Performance Indicators with NHS Highland in the second year to monitor CfWB’s performance in the second year of project, with the Project Manager’s time bring increased to 3 days (22.5 hours) from 2.5 days (18.75 hours). Half of Project Manager’s 3 days’ working time was therefore allocated to:
social prescribing promotion, in particular the development of a social prescribing toolkit
and the other half allocated to: managing the two pilot projects.
Also, given the limited engagement of GPs and other Practice staff with the idea of social prescribing, and the key learning points from Year 1 noted above, a further priority for CfwB’s second year was agreed - to survey Practice staff in the non-pilot Practices across Argyll & Bute with the aim of identifying levels of social prescribing activity and more accurately identifying staff perceptions to social prescribing as well as any actual barriers. This questionnaire was developed and circulated in December 2017; the report based on the findings is attached as Appendix 2.
The Link Worker Pilot Projects
These two projects operated on a part-time basis from the Argyll Street and Bute Practices from February 2017 – March 2018. This involved the CfWB Project Manager liaising closely with the Practice Managers in particular, to ensure the practicalities of basing these projects in the Practices, e.g., effective communication and referral systems, were overcome timeously. Two surveys of Practice staff attitudes were undertaken – one near the beginning and one near the end of the pilot projects. These findings and all other data from the pilots
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have been compiled into an end of pilot evaluation report – attached as Appendix 3.
Case example - the Link Worker approach in action
Initial referral from GP requesting support for middle aged man (A) facing evicted.
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The referral noted that anti-depressants had been prescribed and a referral to Community Mental Health Team (CMHT) had been made, but no support in place as A was waiting for assessment
The Link Worker phoned/wrote to offer an initial appointment – A did not attend for the appointment and subsequent calls from her that week were not answered
Concerned, she contacted A again and left a message to offer a home visit appointment – he did not respond but she did go out at the suggested time and he was at home and prepared to talk
He reported suicidal thoughts but not an active plan – they agreed that she would follow up with the CMHT and make a referral to the Housing Support Team at Carr Gomm, as a worker there would be able to discuss housing options with A
When she called the CMHT, they had no record of the referral and so there was no visit scheduled
She contacted the GP who made an emergency referral; an appointment was made for CMHT to visit the following day
A was also accepted for Housing Support – the Team reports positive progress as they work together to improve his situation, for example, he has been granted an extended notice to quit
This extension allows time for support and joint working from the housing association, CMHT and Carr Gomm Housing Support to ensure a scheduled entry with support into a secure tenancy rather than utilising emergency temporary accommodation.
The social prescribing toolkit.
In close consultation with NHSH and the Social Prescribing Steering group, the following materials were identified as the necessary materials for the toolkit:
An elevator pitch, a summary of social prescribing approaches and benefits
Evidence based case for social prescribing (Dr. Lynne Friedli’s report for Carr Gomm – “The Case for Community Referral”)
3 case studies Public awareness flyer Step by step guide to setting up a Link Worker project (Government
Community Link Worker support pack) End of project evaluation report
Drafts of each item were developed and public consultation undertaken through 2 user groups – generally, the feedback was that jargon should be reduced wherever it was identified The toolkit is attached as Appendix 4.Social Prescribing into the future.
During the lifetime of the CfWB project and the associated Link Worker pilots, a new GP contract has been agreed which includes a social prescribing factor. The learning from CfWB indicates that careful thought should be given to preparatory groundwork to maximise the engagement of GPs with this role, e.g., in Aberdeen,
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inputs from GPs from other areas who had a Link Worker based in their Practice encouraged local Aberdeen GPs to support Link Worker developments through Transforming Primary Care funding. Consideration of similar GP to GP peer events would be useful at the point of the roll out of the social prescribing element of the new contract (anticipated 2020).
Contact Details
For more information about Carr Gomm’s Link Work approach to social prescribing work:
Senior Project ManagerEilidh MacDonald
Email: [email protected]
Mobile: 07798 581135
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Attitudes to Social Prescribing amongst Argyll & Bute Practice staff
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A Social Prescribing Promotion projectin Argyll & Bute
Attitudes to Social Prescribing amongst Argyll and Bute Practice staff (Survey conducted online during December 2017)
Introduction and method
Aims.
To assess attitudes towards social prescribing among health professionals and staff associated with General Practices in the areas of Argyll and Bute which were not involved in the Link Worker pilot projects;
To assess attitudes towards the involvement of reception staff at General Practices taking a role in social prescribing (an initiative which is being trailed elsewhere).
Method and procedure.
A short online survey was developed by the Connections for Well Being Project utilising feedback from NHS colleagues; the survey was circulated by Survey Monkey at the suggestion of Primary Care contacts. This was done on behalf of the Project by the office of NHS Highland’s Primary Care Manager, using the designated communication email address for each Practice, with a request to circulate within each Practice. In total, this means that 31 emails were sent (there are 33 Practices in Argyll & Bute but 2 were excluded, as they are actively participating in the pilots of the Link Worker approach to social prescribing and are therefore completing different monitoring questionnaires).
The survey included questions on the professional role of the respondent and the name of the Practice at which they work. Respondents were not asked for any other information that could identify them. Details of the remaining questions and responses are provided below.
Results.
13 responses were received, representing 12 different General Practices, so typically, 1 respondent per Practice. Respondents were GPs (3); nurses (6); Practice Manager (PM)/reception/administrative staff (4).
Overall the numbers received from rural and town practices throughout Argyll & Bute were similar, with 46.7% (6) from rural and 46.5% (5) from towns and the Islands making up the remainder (2). Therefore, although the survey return rate was low, there was at least 1 response from each of Helensburgh, Lomond, Bute & Cowal, Mid Argyll, Kintyre and 2 Islands areas; there were therefore responses from Practices which reflect all of the geographies of Argyll and Bute.
The responses headed Office in the tables throughout this report incorporate those returns from PMs, Administrative and Reception staff.
Survey results
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Respondents were asked 2 specific questions about their experience of social prescribing in the previous 6 months (see Tables 1 & 2 for wording and response options).
Table 1. “In the last 6 months, have you done any of the following as part of your professional role”
GPs
(n = 3)
Nurses
(n = 6)
Office
(n = 4)
Total
(n = 13)
Advised a patient to contact a community resource
3 6 0 9
Advised a patient to participate in groups or social activities
3 6 0 9
Contacted a community resource on behalf of a patient
1 4 0 5
Referred a patient to another member of staff to help them with social or other non-medical problems
2 4 0 6
All of the GPs and nurses (9 of 13 respondents) indicated that they had, in the last 6 months, advised a patient to contact a community resource, and had advised a patient to participate in some kind of group. A smaller number (6 of 13) had contacted a community resource on behalf of patients. 6 had referred a patient to another member of staff for social or non-medical reasons.
Table 2. “In the last 6 months, have you advised one or more patients to contact any of the following”
GPs
(n = 3)
Nurses
(n = 6)
Office
(n = 4)
Total
(n = 13)
Social Work Department 3 5 2 10
Citizens’ Advice 3 4 1 8
Exercise class 2 6 0 8
Carers’ Centre 2 4 1 7
Support group 1 5 0 6
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Job Centre/benefits agency
2 3 0 5
When asked more specifically about the advice they had given to patients, 10 indicated that they had advised a patient to contact their Social Work Department and 5 advised the Job Centre/benefits agency but referral to third sector or community organisations was the most common option, with 8 advising Citizens’ Advice, 8 an exercise class, 7 a local Carers’ Centre and 6 a support group.
Table 3 shows the reasons given by Practice staff for onward referrals for Practice patients. Mental health, benefits and exercise were catalysts for onward referral in almost every area from which responses were received; in particular, the only area not to record mental health was an Island Practice. It should be noted that the majority of staff who gave mental health as a reason for onward referral also noted debt or benefit advice as an issue. This reflects the experience of Link Worker social prescribing projects in other areas of Scotland, where it has been commonly found that those referred are struggling with more than 1 issue, which makes it difficult for Practice staff to resolve the complex situations reported by the patient as impacting on their wellbeing.
Table 3 Reasons for onward referral
GPs (n = 3) Nurses (n = 6) Office (n = 4) Total (n = 13)
Mental health 3 5 1 9
Benefits 3 4 0 8
Exercise 2 5 1 8
Employment 3 2 0 7
Debt 1 4 0 5
Weight loss 1 3 0 4
Carer Advice 0 0 1 1
Family crisis 0 1 0 1
The impact of social factors such as financial pressures on mental health and well being is now well established e.g., the WHO report ’Impact of Economic Crises on Mental Health’ stated: “Unsurprisingly, substantial research has revealed that people who experience unemployment, impoverishment and family disruptions have a significantly greater risk of mental health problems, such as depression, alcohol use disorders and suicide, than their unaffected counterparts”iand more locally to Scotland, the findings from the GPs at the Deep End Practices included: “An absence or lack of money is having a particular impact on patients’ mental health”.ii
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Respondents were asked 3 questions on their attitudes towards social prescribing, each on a scale of 1 (not at all) to 10 (very much so). A higher score represented a more positive attitude towards social prescribing. The questions were as follows: “To what extent do you believe that the referral of patients to community resources is part of your professional role?”; “To what extent do you believe that your patients could benefit from greater use of social prescribing?”; and “To what extent do you believe that the Practice could benefit from greater use of social prescribing?”
The mean (average) scores for each group are shown in Table 4, with the overall scores for the 3 questions in the bottom row. The figures in brackets are standard deviations; these reflect the variation in the responses, i.e., a larger standard deviation indicates a greater variation among respondents in the answers provided.
From Table 4, it can be seen that Office staff were much less likely to believe that social prescribing was part of their role. Similarly, they were less likely to believe that patients could benefit from social prescribing. All 3 groups were similar in their positive belief that social prescribing could help the Practice. The nursing staff who replied were the most positive in their answers to each of the 3 questions, in particular about seeing social prescribing as part of their own role.
Table 4. Responses to items reflecting attitudes towards social prescribing. Scores are averages on a scale of 1 to 10; figures in brackets are standard deviations.
GPs Nurses Office
To what extent do you believe that the referral of patients to community resources is part of your professional role
7.33 (2.52)
9.00 (1.10)
3.50 (2.38)
To what extent do you believe that your patients could benefit from greater use of social prescribing
9.00 (1.73)
9.50 (0.84)
6.75 (1.71)
To what extent do you believe that the Practice could benefit from greater use of social prescribing
8.33 (2.89)
8.50 (1.05)
8.75 (0.96)
Overall 8.22 (1.84)
9.00 (0.63)
6.33 (0.98)
Respondents were also asked 4 questions reflecting their attitudes towards and the perceived acceptability of social prescribing by reception staff. “It has been suggested that reception staff could, with training and information, play a role in signposting patients to other agencies. How realistic would it be for your reception staff to take this on?”; “If reception staff were to take on a role in signposting patients, how useful do you believe this might be in your practice?”; “To what extent do you believe that patients would take up signposting
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information by reception staff?”; and “To what extent do you believe that signposting by reception staff would be acceptable to GPs and health professionals in your practice?”
Responses are shown in Table 5. Attitudes to the statements were very similar across the professional groups. Overall, respondents were less positive in their attitudes towards social prescribing by reception staff than they were to social prescribing in general. However, there was also much more variation in responses, as shown by the larger standard deviations: some respondents were very negative in their attitudes towards this work being part of the role of reception staff
Table 5. Overview of responses to items reflecting attitudes towards social prescribing by reception staff. Scores are averages on a scale of 1 to 10; figures in brackets are standard deviations.
GPs Nurses Office
…How realistic would it be for your reception staff to take this on?
5.67 (4.04) 5.67 (3.56) 6.25 (2.75)
If reception staff were to take on a role in signposting patients, how useful do you believe this might be in your Practice?
5.00 (4.24) 6.67 (2.42) 6.75 (2.06)
To what extent do you believe that patients would take up signposting information by reception staff?
4.67 (3.51) 5.50 (2.51) 4.75 (3.20)
To what extent do you believe that signposting by reception staff would be acceptable to GPs and health professionals in your Practice?
5.67 (4.04) 6.17 (3.13) 5.50 (2.65)
Overall 5.42 (3.64) 6.00 (2.61) 5.81 (2.60)
Again, nurses were the most positive professional group overall in their responses to these questions but none of the average score responses are high.
Respondents were asked to rate a number of concerns or barriers towards social prescribing on scales of 1 to 10, such that a higher score indicated that the concern was a more substantial barrier. The potential barriers listed in the questionnaire and reproduced below in Table 6 were those identified through feedback from Practice and other clinical staff in the first year of the Connections for Well Being Project, for example, at Practice meetings and a Focus Day held at Lochgilphead Hospital.
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Table 6. Ratings of the barriers towards social prescribing. Scores are averages on a scale of 1 to 10; figures in brackets are standard deviations.
Barrier GPs Nurses Office staffTime constraints 6.67 (3.21) 7.83 (1.72) 4.00 (2.65)Financial constraints 3.33 (1.53) 4.33 (2.80) 4.00 (1.73)Workload constraints 5.67 (3.10) 7.67 (1.86) 8.00 (2.00)Lack of training in this area 7.67 (2.08) 6.83 (2.32) 8.67 (2.31)Lack of knowledge about the availability of local resources or agencies
10.00 (0.00) 8.50 (1.22) 8.50 (2.38)
Lack of knowledge about which resources might be beneficial to patients
9.00 (1.73) 7.00 (1.90) 8.00 (2.16)
The short-term or transient nature of some community or voluntary services or agencies
6.00 (4.36) 8.83 (2.04) 6.33 (3.51)
There are no/very few community resources that could help patients locally
6.67 (3.10) 5.83 (3.31) 7.50 (3.00)
Concerns about the quality or standard of care provided by other agencies
6.33 (2.08) 4.83 (3.31) 6.33 (3.51)
Concerns about data protection or patient confidentiality
2.33 (0.58) 5.17 (2.99) 8.67 (1.53)
Problems with NHS software or 'firewalls' 1.67 (0.58) 5.17 (2.99) 9.00 (1.00)
Other agencies refusing to accept the referral
4.67 (3.10) 3.50 (2.66) 5.00 (4.35)
The ratings suggest that, the GPs who responded in particular felt constrained by their lack of knowledge about local resources, but were much less constrained by practical concerns about firewalls or data protection. Office staff, on the other hand did feel constrained by both concerns about data protection and about NHS software/firewalls, in addition to concern about lack of training. No group in particular seemed concerned about financial implications, nor would that outward referrals from the Practice not be acceptable to other agencies.
Any Other Comments from respondents:
Some correspondents used the option of adding extra comments besides their ratings of the questions. These mostly related to challenges, perceived or actually experienced, in relation to social prescribing:
“We currently use social prescribing but difficult keeping up with all that is available. A single point of referral would be very beneficial as we do not necessarily know all that is available in the community”
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Nurse in OLI
“In a rural area a lot of people will not have transport to get to groups etc. Having more investment in setting up online groups & having group chats might be beneficial. Practices may have an opportunity to help facilitate online, VC (video conferencing) communication as again in rural areas broad band may be poor and the users may have a poor knowledge or skill using a PC.”
Nurse in MAKI
In particular, there was further feedback about the suggestion of the involvement of reception staff in any signposting activity:
“Reception staff current workload is too great. Would need to be extra staff to take on this duty.”
Nurse in B&C
“Reception staff may not know what problem is as patients may be embarrassed to share this but it could work as an additional resource. Time pressures and work load will be a barrier.”
Nurse in OLI
“Reception staff should not be vetting calls - this results in confusion in their role and potential medico-legal issues.”
GP in H&L
One respondent used the Any Other Comments section to note their support of the importance of social prescribing: “I think we should all aim to give good information to patients so they can access the resource which will be of most benefit to them.”
Nurse in H&L
Additional points from Connections for Well Being’s wider work.
One GP who did not engage with the survey was clear that this was because of a disapproval of the approach from their perception: “…I consider social prescribing as medicalisation of normal life and hence I do not support or practise it.” Connections for Well Being staff have also received verbal GP feedback about social prescribing not being a priority for them, e.g., from attendance at Practice meetings.
Connections for Well Being has also developed some case examples of social prescribing in action, and at least 2 local examples identified GPs referring on to
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other Practice staff (in these cases, an OT and a physiotherapist respectively who then went on to engage the patients in community activity) rather than directly socially prescribing themselves.
Summary.
As the survey went out to 31 practices, all of which have multiple staff, 13 responses is clearly a low return rate. This may reflect a lack of engagement by Practice staff with the concept of social prescribing, as highlighted in the Additional Points section above.
It is worth noting that 10 of those 13 who did respond (77%) indicated that they saw “at least once a day” patients whose ailments they thought were caused or made worse by social factors. It may be that this factor (the perception that social factors significantly affect patient well being), is what motivated these staff to reply to the questionnaire, when the clear majority of their Practice based colleagues did not.
Although the numbers are not statistically significant, there are trends amongst the replies, in particular, that the nursing staff were the most positive of the professional groups about referring to resources beyond the NHS. This may interact with the fact, noted in the Additional Points section above, that in the 2 Case Examples, it was not GPs who undertook social prescribing directly; they referred on to other Practice staff who then supported the patient to join community activities such as a Walking Group. Engagement with nurses and allied health professionals could therefore be worth exploring further as a potential starting point for any future social prescribing initiatives in Argyll & Bute.
There was no expressed appetite for reception staff to be involved in signposting to other resources.
Overall however, while these are interesting possibilities, the small sample size means that any extrapolation from this survey must be considered as start points for further exploration, as more data would be required before any firm conclusions could confidently be drawn about Practice staff attitudes to their potential role in referral on to community resources or social prescribing.
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i Impact of Economic Crises on Mental Health, World Health Organisation 2011ii Improving partnership working between primary care and money advice services, Inglis and Egan, Glasgow Centre for Population Health 2016
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