1. Social Prescribing Dr Patrick Hutt (Queensbridge Group Practice)
City and Hackney Social Prescribing GP Lead

2. Overview Background What’s been happening in Hackney? Consortia Pilots
I-Care
Social Mapping Exercise
Evaluation

3. London
Life expectancy decreases from west to east

4. The Inverse Care Law
“The availability of good medical care tends to vary inversely with the need for it in the population served….”
Tudor Hart, Lancet 1971

5. Wealth of Epidemiological Data
Black Report 1980
Acheson Report 1998
Marmot Review 2010

6. Poverty of progress?
All reports similar findings & advocate similar actions:
Early Years/Childhood
Education, Training, Jobs
Housing
Cross –governmental action
Bambra C et al. A labour of Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review. JECH, 2010
Centre stage -

7. What is the role of General Practice?

8. The Deep End
‘Single woman in her 30s asked to do work of several staff at supermarket due to cutbacks. Can’t cope, stressed, makes looking after three teenage school kids with behavioural problems harder. Attends emergency surgery crying +++. Doesn’t know who to turn to so comes to GP. Long, unscheduled, consultation.’ Deep End, 2012

9. Tackling Health Inequalities: Strengths of UK General Practice
Generalist Approach
GPs at the heart of the community
Strong tradition of GPs seeking social change to improve health
IT system that allows population data to be linked to consultations
Kings Fund (2010)
MENTION CONSULTATION DATA

10. Centre Of The Community
GPs know their population
Well placed to sign post patients
GPs are aware of local organisations
GPs are trusted
Able to work together with community groups to tackle local issues
FORTUNATE MAN PICTURE INSERT

11. Picture Quiz

12. Challenges To This Idea
GPs don’t know their local population
Community and Voluntary Organisations find GPs unapproachable, ‘too busy’
Rapid Turnover of Projects
Directories are not up to date
Clinical pathways don’t utilise the potential of local organisations
? Hard to re-create Bromley by Bow

13. Social Prescribing City and Hackney CCG
GPs facilitating better linking between patients and community organisations

14. Positive Benefits Reduction in symptoms (anxiety and depression)
Social Benefits (inclusion, participation, access to new networks)
Practical and material Benefits (debt, housing, benefits)
Skills (employment)
Quality of Life (reducing isolation, loneliness, lack of confidence and self esteem)
Friedli et al, 2009

15. Comments from Dundee
‘I think so yeah [recommending the scheme], if they were sort of in a rut and that, aye…’ (patient)
‘Some patients say they are simply not v good at speaking. I say: ‘this isn’t traditional counselling – simply looking at where you are now, what things are out there that would sit well with your interests to compliment your life.’ (GP)
Friedli et al Sept 2012, Dundee

16. City and Hackney CCG Project Aims
to enable individuals feel more in control, have improved self-esteem and confidence, and self-report an improvement in health and well-being
to reduce social exclusion
GPs and their teams become more aware of what’s happening in the community and vice versa
to support individuals to visit the GP or hospital less as they are managing /coping better
to improve sense of community well-being – mutual support

17. Pilot project timetable :
Phase 1
Planning and development
(key stakeholder engagement and multi-agency project steering and task groups)
March -September 2013
1. GP Consortia identified
2. Service model agreed
3.Service provider agreed
Phase 2
Mobilisation
October December 2013
1. External evaluation provider to be identified
2. Community mapping completed
3. GP Consortia and providers agree referral model and publicity
Phase 3
“Going live”
January March 2015
1. Patients referred to social prescribing project
2. Service monitored and evaluated

18. Pilot project model
GP practices in the 3 consortia test sites will:
Refer patients to a local community activity s/he is aware of and also give patients the option of a referral to a social prescribing co-ordinator for a full assessment and social prescription (using LBH I-Care Well-being Plan).
The patient will also receive a social prescribing (telephone follow- up) with GP practice and a final report from the social prescribing co-ordinator.
Feedback from co-ordinator to GP – 8weeks
Children’s Centres
Icare and a local service direct referral e.g. lunch club
e.g. tea dances
social prescribing co-ordinator(s)
GP practices
e.g. Befriending service

19. Three Pilot Consortia Rainbow and Sunshine Consortium
South West Consortium
Well Consortium

20. Hackney and City CCG Target Groups
socially isolated/withdrawing
presenting with a social problem
struggling/not coping, but do not require crisis intervention ( may have noticed an increase in GP visits)
asking for “low-level” non-clinical activities to help them feel better
Diabetics/Isolated Elderly Population

21. I – Care Website

22. Evaluation Important that we gather evidence Academic tender underway
Please participate where possible
Survey in circulation – please ask colleagues to complete also

23. Summary Social prescribing is coming to a consortia near you!
All practices have access to ICARE – please encourage others to use (it can help!)
Evaluation will be underway
Comments, questions, or suggestions – please

24. “Give me a place to stand on, and I will move the world”
Mechanics Magazine, Knight and Lacy, 1824

25. A GP is a Team Player

26. Primary Care – Now More Than Ever!
Improving Health Is A Team Effort
Primary Care – Now More Than Ever!

27. Thank you for listening! Comments/Questions