1. Update NESTA Social Prescribing Project
Chris Drinkwater
Chair, NESTA Steering Group

2. Condition specific care pathways
COPD, Diabetes, Obesity, Mental Illness, Older People, Learning disability
Social
Medical
Initial assessment/stabilisation
Annual care planning
Lead Non-Traditional Provider
Menu of activities related to needs/dependency
Self care
Minimal support
Moderate support
High support
Own programme
Direct access to services with initial induction and regular review
Link worker
personalised programme and intensive review

3. The Plan
1.Develop a link work service within existing voluntary organisations which will enable HCPs to refer (vulnerable) people with LTCs to non clinical community services and networks.
2.Raise awareness and equip HCPs to use this service through roll out of care planning training and support to all local practices.
3.Develop and maintain a comprehensive web-based information resource to support this programme -

4. Commissioning the Link Work Service
More than signposting – ability to engage, support and challenge people to change behaviours.
Key competencies – understanding your community and understanding behaviour change.
Aim to create autonomy rather than reinforce dependency.
Costs, case load, work with volunteers.

5. The plan 200 patients to be recruited from 6 practices
5 Link work providers;
- Age UK Newcastle
- HealthWORKS
- Carers Centre
- Search
- West End Befrienders

6. Progress to Date Around 100 patients
New client group often with complex high level needs – particularly mental health.
Majority being referred to HealthWORKS (73%), Age UK (22%) and Carers Centre (6%).
70% referrals over 50s
Age UK – men 50s-60s, living alone and not in work
Pilot community buddy service
Preferred activities – DIY courses/furniture restoration.

7. Commissioning Activities
Group rather than individual based
What sort of activity?
For how long?
What sort of quality control?
Who holds the activity budget – patient, link worker, commissioner?
How do you reward/incentivise outcomes?

8. Annual Local Service Review
Commissioners, referrers, service users and
service providers.
What does the annual review data tell us?
What is working well and what needs to change?
Is the service cost-effective?