Social Prescribing - Tim Anfilogoff and Dr Marie Anne Essam

‘Social Prescribing’ Connecting People for Health in Hertfordshire England and the World!

Tim Anfilogoff, Head of Community Resilience Dr Marie-Anne Essam Herts Valleys CCG

Contents • Demystifying Social Prescribing • Putting it in Context – what can it achieve?

• Our Hertfordshire model • National SP Network • NHSE Commitment and support

Demystifying Social Prescribing Kind of a frightening name?

Social Prescribing: 1806 The patient: • overcome by a terrible sadness • didn’t want to get up in the morning • could not see any point in his existence

Social Prescription The Doctor: • I would normally prescribe a course of my patent powders…

• But instead….

Co-production?

The patient: Ah, but doctor‌.

Adapted from: www.historyextra.com/period/the-patient/

The most important elements of the process are: A) What matters to you?

B) What do you think will work for you?

https://www.westminster.ac.uk/patient-outcomes-in-health-research-group/projects/socialprescribing-network

Case Study 1: John

Putting it in context England and Canada are different – but not that different?

What problems can SP solve?

Social Determinants of Health (Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute)

• Health behaviours

30%

(smoking 10%, diet/exercise 10%, alcohol 5%, poor sexual health 5%)

• Socio-Economic factors

40%

(education 10%, employment 10%, income 10%, family/social support 5%, community safety 5%)

• Built Environment

10%

(environmental quality 5%, built environment 5%)

• Clinical interventions (access to care 10%, quality of care 10%)

20%

Everyone has a GP • Obvious place to promote social interventions to support clinical outcomes • But they only have ten minutes (in England)!

“I don’t know what is available from the voluntary sector and I don’t always have the time to find out, but the Community Navigator does, and makes sure the support my patients get lasts.” GP

Impower Home Truths Survey, Herts 2013 GPs’ concerns: • Low trust for social workers • Social care unresponsive - eligibility • Worried about managing demand

Social workers’ concerns: • GPs make inappropriate referrals • GP unrealistic expectations - eligibility • Worried about managing demand

Consultants’ insight: GPs’ poor knowledge of community provision – even if on own noticeboards!

Consultants’ insight: Social care working practices not aligned to GPs …need more early intervention

England Context: Adult Social Care • Austerity • Social Work eligibility-based since 1990 • Reductions in access to publicly funded social care • Longevity requires reappraisal

England Context: Primary Care • GP workload up 16% (2007–14): RCGP • More multiple, chronic conditions – workload increasing: RCGP • Av. GP consultation (10 mins) shortest in developed world*?

• Long-term conditions make up 50% of GP appointments** • Consultation length affects ability to empower patient…*** • If OP saw regular GP two times more out ten - 6% decrease in admissions for ambulatory sensitive conditions**** *www.theguardian.com/society/2017/feb/07/gps-consultation-times-too-short-for-complex-cases-says-doctors-leader ** www.england.nhs.uk/ourwork/ltc-op-eolc/ltc-eolc/house-of-care/ ***www.ncbi.nlm.nih.gov/pmc/articles/PMC4311338/ **** https://www.health.org.uk/publication/emergency-hospital-admissions-england-which-may-be-avoidable-and-how

England Context: Primary Care (2) • 20% GP face-to-face time spent on non-medical issues* • 15% GP time spent on ‘welfare’ issues** • Risk of missing 20% of what matters most to patients if don’t start with that question*** • Recruitment problems and Brexit impact *www.citizensadvice.org.uk/Global/CitizensAdvice/Public%20services%20publications/CitizensAdvice_AVeryGen eralPractice_May2015.pdf ** www.lowcommission.org.uk/ ***http://journals.sagepub.com/doi/abs/10.1177/1534735414555809

England Context: Secondary Care

Evidence from Rotherham Model Rotherham CCG, every GP involved, standard NHS Contract

Voluntary Action Rotherham, team of health advisors

Community Groups, 23 funded to provide a menu of 33 services and spot purchasing

IMPACT (Independent evaluation by Sheffield Hallam University)

• In-patient spells reduced by 11% • 17% drop A&E attendance for all patients • For those under 80 now receiving long term support from voluntary and community groups, 51% drop in-patient stays, 35% fall in A&E attendances.

Other evidence of SP impact

Impact on A & E • Mr X, homeless, many problems: alcohol, depression, cellulitis of leg, foot ulcer…

• Attended ‘navigator clinic’ • Refused many things but accepted: • Practice nurse for leg dressing • Meeting with housing officer • Crisis intervention service

--> Less use of A and E

Mr X said: ‘[Navigator] helped me to get support from my GP and fill in housing forms as I am dyslexic. She has listened to me when I am having a really bad day as often that’s all I need.’

The town that’s found a potent cure for illness - community 21 February 2018

@GeorgeMonbiot

Frome (Somerset) sees dramatic fall in emergency hospital admissions since collective, community work to combat isolation

https://www.theguardian.com/commentisfree/2018/feb/21/town-cure-illness-community-frome-somersetisolation

Loneliness is bad for you Loneliness and physical health • Increases the likelihood of mortality by 26% • Comparable to impact of obesity or cigarette smoking • Associated risk of developing coronary heart disease and stroke • Increases the risk of high blood pressure and risk of onset of disability Loneliness and mental health • Greater risk of cognitive decline • One study suggests 64% higher chance of developing dementia • Lonely individuals more prone to depression • Loneliness/low social interaction are predictive of suicide in older age https://www.campaigntoendloneliness.org/threat-to-health/

Loneliness is bad for the health system Lonely individuals more likely to: • Visit GP • Use more medication • Have falls • Have risk factors for long term care • Go early into residential or nursing care • Use accident and emergency services independent of chronic illness https://www.campaigntoendloneliness.org/threat-to-health/

Arts can help recovery from illness and keep people well, report says All-party inquiry shows benefits to health and wellbeing include fall in hospital admissions

http://www.artshealthandwellbeing.org.uk/appg-inquiry/

Impact on use of ambulance service

Family Caring/Care-giving and reduced wellbeing • High levels of care - 23% higher risk of stroke • Older carers under ‘strain’ - 63% higher death risk pa* • 58% reduced exercise, 69% can’t sleep, 73% more anxious, 82% more stressed, 45% eat less healthily, 50% ‘depressed’** • Carers miss own health appointments and 39% postpone treatments - can’t leave person cared for *** • 40% significant distress/depression; increases with time devoted to caring - adverse effects evident beyond end of caring**** *Haley, W et al (2010), ‘Caregiving Strain and Estimated Risk for Stroke and Coronary Heart Disease Among Spouse Caregivers’. Stroke, 41:331-336. **Carers UK, State of Caring Survey 2014 (n= 4,924 current carers) ***In Sickness and In Health, Carers UK, 2012 **** Supporting Carers: An action guide GPs, Royal College of General Practitioners

Supporting Carers to be Healthy and Connected

Carers and SP Agenda must be joined up • SP works for family carers – Poster at Conference (TODAY) in Salford, England!

2009-2015 (Quality Metric SF 12)

Standard Population

Carer before social prescription

After social prescription

Evaluating Social Prescribing

NHS England and National SP Network consulting on key outcomes (NB – not on standard interventions)

Do GPs need convincing still in England?

Professor Stokes-Lampard, chair RCGP calls for universal GP access to SP http://www.rcgp.org.uk/aboutus/news/2018/may/rcgp-calls-ongovernment-to-facilitate-socialprescribing-for-all-practices.aspx

• Every GP should have access to dedicated SP (RCGP, May 2018) • SP one of most effective ‘10 High Impact Actions’ - good for practices and patients • 59% of GPs think SP helps reduce workload • University of Westminster review: average drop of 28% in demand following SP

https://www.westminster.ac.uk/patient-outcomes-in-healthresearch-group/projects/social-prescribing-network

Case Study 2: Jay

The Hertfordshire Model Key elements

Hertfordshire Directory (12,000 community groups for 1.1m people)

Networking infrastructure and single point of access (since 2011)  Web – Hertshelp.net  Text – HertsHelp to 81025  Email – info@hertshelp.net  Skype - HertsHelp  Minicom on 0300 456 2364  Fax 0300 456 2365  Telephone 0300 1234 044 or Text HertsHelp to 81025  Face to Face advice – arrange on 0300 1234 044  Advocacy – via professional referral  Communication Toolkit - BSL, Makaton, Braille Service

0300 1234 044

Key Stats • Monthly calls 1700 • Refers to 120+ different organisations per month • Commonest referrals include: - Citizens Advice (benefits, debt) - Age UK - Carers in Herts etc

• Often multiple referrals • But some people can’t manage the phone…

Top 15 lines (alphabetical) of the 123 groups receiving 1554 onward referrals in August 2017

Community Navigator Scheme (as at September 2016) Scheme Manager HVCCG/HCC

Community Navigator Dacorum

Community Navigator St Albans and Harpenden

Community Navigator

Community Navigator

Watford

Three Rivers Projects and frequent attender navigator

Relief Navigator

Hertsmere navigator Single practice pilot

HertsHelp calls the person following referral

Person able to discuss needs over the phone or via email

HertsHelp arrange calls/visits directly

Person needs face to face visit at home/ meet at surgery

Community Navigator makes visit (since 2014)

Onward referral, typically to four or five sources of support

(12,000 community groups)

Person calls HertsHelp

Community navigator co-produces support plan

Too upset, too confused, too deaf, too distracted by crisis, too many issues, low motivation etc

Case Study 3: Jane

The National Social Prescribing Network Tools and networks you can make use of

http://westminsterresearch.wmin.ac.uk/19629/

Evaluation Data A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications Polley, M., Bertotti, M., Kimberlee, R., Pilkington, K., and Refsum, C.

http://westminsterresearch.wmin.ac.uk/19629/

https://www.westminster.ac.uk/patient-outcomes-in-health-research-group/projects/social-prescribing-network

NHSE commitment and support NHS England are fully supportive

“Social prescribing is a new way of helping people get better and stay healthy…

It would be good to see all GPs considering whether their patients might benefit.”

Simon Stevens, CEO, NHS England 46

NHS England: Plan on a Page Aim: To make social prescribing more systematic and equitable, by supporting the spread of local social prescribing connector schemes, which employ link workers, help people around ‘what matters to them’ and connect them with community support.

Increase local connector schemes

Build the Evidence Base

Help leaders to develop and plan

Produce an online resource repository and bite-sized resources

Develop a Common Outcomes Framework for Measuring Impact

Develop Regional Social Prescribing Networks

Commission an in-depth Evaluation of Social Prescribing Connector Schemes

Support the creation of a Quality Assurance Framework for SP Connector Schemes

Work with Integrated Care System demonstrator and test sites

Put SP codes in General Practice IT Systems

Work with Defra to support mental health providers to connect people to the environment

Support the DH Health and Wellbeing Fund

Explore whether SP referrals can be the NHS BSA Prescriptions dashboard

Develop and pilot learning for link workers

Work with CCGs to map local SP connector schemes

Work to date • Mapping (ongoing): 900 link workers in England?

• Funded Evidence Review and Making Sense of Social Prescribing in 2017 • 2018-19 funding regional ‘facilitators’ and events • Common Outcomes measures being consulted on

Final words: GP: ‘I have had amazing response from people coming back to tell us what a help the referral has been and how surprised they were to find out what help was available to them.’

Client: ‘Before I met the community navigator, my life was very bleak, I wasn’t able to go out, I wasn’t able to meet people, there was no one around in my age group that I could go meet. Since having a community navigator in my life I am able to get out more, enjoy myself more and now also from years back can see the light at the end of the tunnel, and I’ve not seen that for a long, long time.’

Let’s stay in touch Tim Anfilogoff Head of Community Resilience, HVCCG

Dr Marie Anne Essam MB BS MRCGP MBA, General Practitioner, UK

National SP network steering committee Co-chair East of England Regional network Regional SP facilitator for NHS England

Clinical Lead & Ambassador for Social Prescribing

• m +447900 161673 • e tim.anfilogoff@nhs.net

• m • e • t

+447949 430687 marieanneessam@nhs.net @marieannedoc