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

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

3. 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

4. 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

5. Social Prescribing Process1.
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

6. 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

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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. THANK YOU
ANY QUESTIONS?

19. 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

20. 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

21. 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