Social Prescribing in Wandsworth Dr Mohan Sekeram, Clinical Lead for Social prescribing Tanya Stacey, Senior Primary Care Commissioning Manager 3rd June 2019

Workforce DES provides workforce reimbursement to build expanded Primary care team Year 1 (per PCN, approx. 30-50k population) 1 Clinical pharmacist (70/30 split) 1 Social Prescriber (100% funded) Year 2 PA, Paramedics, MSK..

Introduction to Social Prescribing Links patients to ‘non- medical’, community based sources of support (20 %) Housing, Debts/ benefits, social isolation , employment.. Determinants of health (deprivation) Provides GPs with ‘non- medical’ referral option Medical model Psychological – Social Depression -> bereavement Infections -> housing

Current Model (East Merton) ‘Link worker’ – aka Social Prescribing Coordinator embedded in primary care Computer systems Supervising clinician to help support SNOWMED codes (*) GP refers patient to Coordinator with referral reason, i.e: Socially isolated Frequent GP attender Mild/moderate mental health issues Social needs Coordinator Advises and signposts

Social Prescribing Process 1. Link Worker at practice 2. GP: Completes referral form Gives SP booklet to patient 3. Link worker reviews patient and documents on Emis Completes wellbeing star (PAM to be included soon) 4. Advises and signposts

Social Prescribing Key Themes The Social Prescribing Coordinators help patients access local organisations across sectors who offer support with: Social aspects of healthy living - diet and exercise and non-medical support to manage a long term health condition. Anxiety and depression Housing and finance Employment and volunteering Practical support at home and keeping safe Loneliness and social isolation Carers support Bereavement

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

Collaboration with Stakeholders is Key Practices Voluntary sector (employers / linking other) Public health CCG Federation

EVALUATION( ref appendix) (QUALITATIVE) 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 ) Not thinking about it Finding out Making changes Getting there As good as it can be

GP APPOINTMENTS AT 3 MONTHS This box chart shows the number of GP appointments patients attended three before and after their first Social Prescribing appointment. 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). APPOINTMENTS 3 MONTHS BEFORE SP APPOINTMENTS 3 MONTHS AFTER SP Average apps: 12 Average apps: 8

Social Prescribing in Action Patient B seen before Christmas 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 – Nov 2018 Currently working and off medication and no more medical certificates. Self esteem Resilience Supporting community Reduced use primary care

The Current Model (Merton) Funding required for current model: c£50,000 per Navigator, including overheads and development costs. This includes: Training needs assessment and delivery Funding of voluntary sector Peer and individual supervision delivery Support for the Coordinators Provider engagement with local voluntary sector Monitoring of referrals and activity, input into evaluation Monitoring of impact on voluntary sector Stakeholder engagement Role and responsibility development Estates cost for the base location

Benefits to Primary Care Health and wellbeing of practitioners Utilisation of resources Collaborative working / identify resources Mindful of effect on Voluntary sector.. (evaluation) Challenges Funding and support/evaluation of voluntary sector Support and supervision for Social Prescribers

Primary Care Networks (PCNs) Impact of New GP Contract Movement towards integrated care systems New Directed Enhanced Service (DES) contract – PCN development In 2019/20 (from July) each PCN can receive c£35k to employ or sub-contract the employment of a Social Prescribing Link Worker (covers staff salary costs only) Applies to new staff and not payment of existing staff. Consider quality assurance / support

Moving Forward.. How do we support Social prescribing and continue momentum ..? Proposal: If PCNs agree with the proposed model, it is suggested that; CCG supplement 35k to 50k to ensure an effective model and not simply salary costs – result is 1 Coordinator per PCN in each borough (assuming PCN interest) CCG would manage the contract with the Providers – reduces strain on PCNs Successive years: as per NHSE guidance we will develop the model to allow for additional further social prescribers, in collaboration with views of the PCNs and area need

Procurement Timelines July – Go out to tender for 2 weeks Use the remaining weeks in July to evaluate applications and conduct bidder interviews August – Award contract and allow 6 weeks for mobilisation Mid-September/October – Commencement of Service and deployment of Social Prescribers to Wandsworth PCNs

THANK YOU ANY QUESTIONS?

Possible KPIs ( Personalised CP) ( ?to report from 2020) Monitored via a primary care network dashboard 1. Number wte link workers per 10,000 population 1 per 10,000 population by end 22/23 2. % of population who have accepted a social prescribing referral (ie being supported by social prescribing) each year 1% 20/21 2% 21/22 3% 22/23 3. % of GP practices within primary care network who are able to refer to and involve link workers in practice meetings 100% from 20/21 4. % of link workers (funded by NHSE) who have received accredited training 90% by 22/23

Proposed Measures of Impact Office of National Statistic Wellbeing scale (ONS4) Patient Activation Measure (PAM) Highly motivated good control Poorly motivated good control Poorly motivated bad control Highly motivated bad control

A&E APPOINTMENTS AT 6 MONTHS This box chart shows the number of A&E appointments patents attended six months before and after their first Social Prescribing appointment. 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). A&E APPOINTMENTS 6 MONTHS BEFORE FIRST SP A&E APPOINTMENTS 6 MONTHS AFTER FIRST SP Average visits: 1.4 Average visits: 0.7