Hello, I am Dr Alison Fixsen, a Senior Lecturer in Psychology at the University of Westminster. I’ve worked extensively in the healthcare sector and have been researching non-medical approaches to health and wellbeing for decades. One approach is social prescribing. This is where General Practitioners (GPs) or other frontline professionals refer a patient to a social prescribing coordinator or a ‘link worker’ to ‘co-produce’ a ‘social prescription.’ Normally social prescribing entails a face-to-face meeting with the coordinator, followed by a referral to a local community health and wellbeing intervention or activity, such as counselling, an art class or a walking group. These ‘social prescriptions’ are intended to help people improve their health, wellbeing and connect with others in their community.
There is emerging research on the health, social and wellbeing benefits of social prescribing. But in this blog, I talk about both opportunities and barriers to successful social prescribing schemes. I talk about a project which, with the help of my research team, I carried out in urban and rural Scotland during year one of the Covid-19 pandemic. I discuss some of the key findings from the study, see here for the full article.
We chose Scotland for our study because it is the country with the highest level of deprivation in Europe. We focused on three schemes (i) the Glasgow Links Worker program; (ii) SPRING social prescribing in Glasgow and (iii) mPower Community Navigator scheme in the Western Isles. We thought it important to explore the different challenges to the schemes, how they adapted to the new conditions, and what this could mean for the future shape of social prescribing. Our participants included social prescribing coordinators, GPs, managers, researchers and representatives of third sector organizations.
Diversity of social prescribing approaches.
Our findings revealed a complex social prescribing landscape in Scotland with schemes funded, structured and delivered in diverse ways. Participants talked about how they felt their model of social prescribing differed from others, highlighting different approaches to referral and selection criteria. Stakeholders in the Link Worker program described the integration of the link worker into the GP practice as key to success, whereas the SPRING community-based social prescribing emphasized the value of having their advisors located near the community activities and ‘cutting out’ the medical association.
Operating in remote areas, the community navigators visited clients in their homes, placing emphasis on educating clients about digital technology and self-managing their chronic health conditions. Across all the interviews, participants talked about the social prescribing coordinator being at the center of operations and how building and maintaining relationships was central to the success of any social prescribing scheme – especially challenging in light of ramifications of Covid-19.
Responses to the pandemic.
For both GPs and social prescribing coordinators, working properly during the pandemic had been challenging and demanding. Digitalization of services have needed to take place rapidly and all coordinators became home workers, which required professional and personal adjustments. In areas of high deprivation and multi-ethnicity, health services were especially over-stretched, and everything had been ‘more of a battle.’ In both rural and urban areas, identifying sheltering and vulnerable people and combatting loneliness and isolation had been key to the coordinator role. A positive outcome of the shift to online service provision and activities was that it had benefitted clients unable or unwilling to attend physical, in-person sessions.
One unfortunate effect of the pandemic was the temporary or permanent closure of many third sector services, such as youth centres, a domestic abuse charity and all face-to-face community activities. With diminished health and community resources and extensive mental health waiting lists, social prescribing coordinators had taken on new responsibilities, including delivering foods and medicines and supporting clients through mental health crises. Over the months, the social prescribing coordinators became more adept and creative in setting up digital activities such as exercise and cookery classes and were providing socially distanced walk and talk sessions. Their hard work was greatly appreciated by GPs who needed to focus on medical issues at the expense of psychosocial problems
Conclusions.
We think of social prescribing services in Scotland as a “collage of practices” superimposed on a struggling healthcare system and third sector. SP services, while growing in popularity, remains ‘peripheral’ in terms of government funding and resources, suggesting them to be undervalued compared to mainstream medical initiatives. At the same time, our shakeup of the normal order could provide a means of identifying the intersections between health and other inequalities and specific areas requiring improvement.
The project was supported by the Health Innovation and Wellbeing Community, which is one of four research communities at the University of Westminster.
