A revolution in social prescribing

Source: PSE April/May 2018

John Craig, chief executive of Care City, on a new GP system that automatically creates a social prescription based on patient information.

Social circumstances are around twice as significant to people’s health as medicine. But, paradoxically, the evidence for medical interventions is stronger. While we know that social circumstances are vital, promoting and evaluating social prescribing is tough. However, there is a chance that digital technology can make the difference.

Social prescribing has been a ‘next big thing’ for many years, but it has changed few mainstream services. At Care City – an NHS England test bed – we recognise that the first response is to make it easier for GPs. As one GP said to us, time pressure means that “opening another window is a deal-breaker.” Normally, this means enabling GPs to make a referral to a ‘link worker,’ who then connects a patient to social interventions. This will always be necessary for some, who need intensive support to break out of isolation or damaging lifestyles. But the cost of this approach means too often social prescriptions are tightly rationed.

Care City collaborated with Health Unlocked – the web brains behind online peer support from Macmillan and the British Heart Foundation – to build a plug-in to GPs’ EMIS system that instantly creates a social prescription without the need of a link worker, all based on information about a patients’ health and circumstances and drawing their address from their record. Our GP partners are now connecting their patients to the walking clubs and peer support groups that have the potential to change their lives.

This system is live with seven practices in Barking & Dagenham, and the feedback from patients and GPs is excellent. GPs’ colleagues in local authorities are interested too, because social isolation generates costs for social care. Care City believes that this kind of social prescribing – designed to work at scale, and at low cost – has the potential to drive powerful collaboration across health and care, keeping people well and independent for longer.

However, in the long run, to grow social prescribing GPs need to see the quality of evaluative evidence that they take for granted. For too long, we have assumed this is too hard to obtain, but digital technology has a habit of upending these assumptions.

Until recently, the running joke of advertising was that half of all budgets are wasted, but no one knows which half. The move online means we do now know what works, and the impact on other media has been severe. In advertising, digital has irrevocably changed what counts as acceptable impact data.

For Care City, the next step is to document on the GP record exactly what is socially prescribed. The potential is huge, enabling researchers to spot patterns between social prescriptions and changes in patients’ usage of services.

As this work develops, we shouldn’t take the old assumptions about impact data for granted, including the idea that pharmaceutical evidence represents a gold standard. In medicine, we tend to know a huge amount about the effects of drugs under controlled conditions. But we know far less about whether people take them.

The difference with digital medicines is that we know exactly who logs on and when – and if and when they give up. Equally, as efforts to help clubs and charities to enable people to ‘check in’ via smartphone gather pace, some social prescriptions will start to develop adherence data too. So long the benchmark, digital innovations in prescribing may do more than level the playing field for social interventions – they may see medicine playing catch-up.




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