How to get buy-in for Social Prescribing

1. SOCIAL
PRESCRIBING
Getting ‘buy in’
Dr. Mohan Sekeram, Clinical Lead
Social prescribing
Wandsworth and Merton

2. Overview
• Why Social prescribing ?
• Merton model
• Model in Long term plan
• Working for primary care networks
– ‘Buy in from primary care, Council, VS.’
• Opportunities
• Challenges

3. INTRODUCTION WHY ?
TO SOCIAL PRESCRIBING
- Links patients to ‘non-
medical’,
community based sources of
support (20 %)
- Housing, Debts/ benefits,
social isolation , employment..
- Determinants of health
- Provides GPs with ‘non-
medical’
referral option
- Medical mode
Psychological – Social

4. • DEPRESSI
ON
OTHER CAUSES TO SYMPTOMS W
• BEREAVEMENT
• HEART PROBLEMS • FINANCIAL
CONCERNS
• RECURRE
NT
INFECTIO
NS
• HOUSING
ISSUES

5. Social Prescribing Service Key Aim( How)
To connect people with local activities
and services across Merton which can
make life more enjoyable and/or provide
practical support
Via Link worker/ social prescriber

6. Link worker at practice (embed into primary care)
PROCESS (
how)
1.
GP:
- Completes referral form
- Gives SP booklet to patient
Link worker reviews patient and documents on Emis
Completes wellbeing star
Advises and signposts
2.
3.
4.

7. - Patient stories
- Wellbeing Star (used at baseline
and follow up)
- 75 patients had completed two
stars, with an average increase in
overall wellbeing score of 0.7;
Increase from 2.8 to 3.5. Statistically
significant
(t = 1.99; p = 0.00 )
EVALUATION
(what)
(QUALITATIVE)
1. Not thinking about it
2. Finding out
3. Making changes
4. Getting there
5. As good as it can be

8. - 138 visited the GP within 3
months of SP.
- They took up 1,641 appointments
before SP and 1,098 afterwards
(reduction of 543).
- The average number of
appointments per patient reduced
from 11.9 to 8.
- T-test analysis shows that this is a
highly significant reduction in the
number of appointments
(p value = 0.00).
This box chart shows the number of GP appointments patients attended three before
and after their first Social Prescribing appointment.
GP APPOINTMENTS AT 3 MONTHS
APPOINTMENTS 3 MONTHS BEFORE SPAPPOINTMENTS 3 MONTHS AFTER SP
AVERAGE APPS:
12
AVERAGE APPS:
8

9. - 36 patients visited their GP within
6 months of SP.
- They visited A&E 60 times before
SP and 31 times afterwards
(reduction of 29 visits).
- The average number of
appointments per patient reduced
from 1.4 to 0.7.
- T-test analysis shows that this is
a significant reduction in the
number of appointments (p value
= 0.04).
This box chart shows the number of A&E appointments patents attended six months
before and after their first Social Prescribing appointment.
A&E APPOINTMENTS AT 6 MONTHS
A&E APPOINTMENTS 6 MONTHS
BEFORE FIRST SP
A&E APPOINTMENTS 6 MONTHS
AFTER FIRST SP
AVERAGE VISITS:
1.4
AVERAGE VISITS:
0.7

10. Reduction in GP appointments
• Rotherham study – 28 % reduction in F2F
• Hackney – reduced by 21 % ( 6/12 post)
• Tower hamlets –reduced by 12.3 % ( 6/12
post)
• Bexley – reduction in non- elective admissions
of 60% ……

11. - Patient B seen before Christmas
2017 for Depression and medical
certificates. Seen monthly for 4
months
- Saw Ray- Identified he work as
chef and other benefits.
- Job at community center ( July
2017)
- Bottom photo – November 2018
- Currently working and off
medication and no more medical
certificates.
- Self esteem
- Resilience
- Supporting community
- Reduced use primary care
SOCIAL PRESCRIBING
IN ACTION

12. Buy in from primary care
• Showing quantitative data
• Seeing qualitative date – can see patient
types…..
• Easy process to referral
• Embed in primary care ( member of the team)
• Feedback and outcome..

13. Personalised care
• One of the 5 key priority areas in the LTP.
• Patient choice and control
• Takes whole system approach integrating
services
• 6 enablers

15. Primary care networks
• DES provides workforce reimbursement to build
expanded Primary care team
• Year 1 ( per 30—50k population )
– 1 Clinical pharmacist (70/30 split)
– 1 Social prescriber ( 100% funded)
• Year 2
– PA, Paramedics, MSK.. (or second social
prescriber)
• Year 3 ( 3rd social prescriber ) ……….

16. Potential Support for Networks
• Create Personalised care plans
• Diabetic input- healthcoaching
• Dementia awareness
• Home visiting ?
• Social determinants
• Embed into MDT team

17. Buy in from Voluntary sector
• Include in the journey
• How will it impact them
• Align services and not compete
– Acknowledge what is existing
• Funding for voluntary sector
– Evaluate
– Ccg, bids for charitable funds, social
enterprise… etc (Mark swift – wellbeing )
• Volunteer staff

18. Rough runner Oct 2019( Team Merton)raised 3k

19. Buy in from Council
• What is strategy
– Focus on community, preventative
• Build network connectors
• Health & wellbeing board
– Similar aims
• BCF/Steering grp/Evaluation
– Born June 2016
• Joined party August 2016

20. Factors to support scheme
• Collaboration/ engagement with stakeholders
– Public health, Voluntary sector, primary
care..
• Identify needs in area , deprived vs affluent,
young vs old, JSNA
• Steering group meetings (composition )
• Evaluation
• Support for voluntary sector and Social
prescriber

21. MERTON PATIENT STORY

22. Challenges
• Getting right model for your area..
• Not seeing full benefits.. ( uptake year 2)
• Engagement of all voluntary sector (small)
• Funding for voluntary sector ( demand)
• *Support and supervision for Social prescribers
• *Evaluation of impact on Voluntary sector
(downstream)

23. Opportunities
• NHSE pledge funding for 1000 link workers by
end 2020/2021
• Integrate with community.
• Promotes health and wellbeing and reduce
health inequalities.
• Reduce impact on primary and secondary care
• Health and wellbeing of practioners.

24. THANK YOU.
ANY
QUESTIONS?
www.dontmedicalise.com
Instagram - Social_doc_prescriber
Twitter - @SekeramMohan