Evaluation of Social Prescribing in City and Hackney Dr Marcello Bertotti (Senior Research Fellow), Caroline Frostick (Research Fellow) Institute for Health and Human Development University of East London

Social Prescribing City and Hackney CCG New Age Games 22 GP practices 85 organisations3 SP Coordinators 585 referrals (Feb 14- Mar 15)

Evaluation Independent Evaluation (UEL and Queen Mary) Qualitative interviews with 20 participants Quantitative (baseline and 8 months follow up) Control Group – patients matched Economic evaluation Process evaluation – learning events, interviews with Wellbeing coordinators, community organisations, GPs GP online survey

The good news… “The model is a strength, it changes people’s lives. It’s about having time to sit down with people and give them the individual support that they need - treating them like a person.” “Social Prescribing is helping clients to become more autonomous as they are encouraged to set their own goals and generate ideas for themselves rather than being told what to do by their GP’s. Being asked ‘Well, what do you want to do?’ for the first time can be big thing for some people.”

What went well… Community organisations reported that clients are being referred appropriately and have accurate expectations the service available. The relationship between Family Action and the community organisations worked well, with project managers in particular feeling well supported by Family Action’s wellbeing co-ordinators. There is a richness and diversity of organisations to refer to in Hackney and City and the Social Prescribing initiative helped to advertise projects and fill spaces which in turn helps to keep the projects alive. Interventions are on people’s doorsteps and within their communities where they can extend their relationships and don’t have to travel. Clients are expected to engage and make friends and they do. Attendance is very consistent and people don’t drop out because they want to be there. They are making friends and finding it beneficial.

Success stories – Ms E: “It’s done me a world of good; taken me out of the house, given me a routine and given me a sense of purpose and…hope. It’s given me back my confidence.” “The depression had taken so much from me and that (volunteering) was giving me something back. It allowed me to keep my hand in so when I was ready and able to go back to work to work - I wouldn’t have been not working been since I’ve got references and skills that are current. And being able to help somebody else.” “It gave me hope, it gave me a sense of purpose, it gave me an avenue for dealing with what was going on for me without feeling like I was being a burden to someone.”

OUTCOME SURVEY NOT SIGNIFICANT CHANGE BETWEEN BASELINE AND FOLLOW UP

Outcome evaluation Intervention led by QMUL: 184 SP participants were sent a questionnaire at baseline and 8 months follow up Control led by UEL: 3,000 patients from 6 GP practices matched to intervention also baseline and follow up. (n= 302) Measures: health, well-being, anxiety, depression, social integration, QoL No stat significant change in these but it is early days.

Outcome evaluation (cont) Measures: health, well-being, anxiety, depression, social integration, QoL SP users were anxious and depressed at baseline There were differences between interventions and control sample in terms of level of isolation No statistically significant change in gen health, wellbeing, anxiety, depression social integration, QOL at 8 months

Economic evaluation These data still to be analysed However, A&E attendance decreased slightly over the period whilst it increased in the control And consultation rates have declined..

377 Social prescribing users 7540 matched non-users ANNUAL CONSULTATION RATE ONE YEAR BEFORE AND ONE YEAR AFTER REFERRAL All values are statistically significant

PROCESS EVALUATION

Key learning Contribution of SP coordinators is key to success Most GPs are on board Community organisations also on board

Key issues Low number of referrals from GP practices “The terrible thing is that I referred five but I should have referred about 15 times that. Although I am very enthusiastic about it, it is hard to keep in front of your mind, and that’s the challenge!” (General Practitioner)

Key issues (cont.) Participants do not recognise SP Need a feedback loop of positive patients’ experiences to GPs to increase referrals Participant suitability. A proportion of patients referred to Family Action didn’t meet the criteria for Social Prescribing. They were either above or below the threshold. Some community organisations did not know patients had been referred as part of SP Cultural differences Patients  Clients  People Lack of funding for community organisations

Conclusions Social prescribing pathways are being developed around UK (at least 90 projects) Skill set of Co-coordinators Key Qualitative data: users had a very positive experience Quantitative data shows no sig change but metrics for Social Prescribing in relative infancy Need to use different tools (e.g. Patient Activation Measure) Economic evaluation shows potential savings Key issues is low number of referrals from GPs, branding and resources for community organisations