Look Who's Talking: Dr Marie-Anne Essam. The 'Godmother of Social Prescribing'

Article by Dr Marie-Anne Essam, GP.

I’ve been a GP for 30 years, and for the last 15 years involved in trying to integrate care around patients. People’s health is dependent, however, on a lot more than the clinical aspects and the help provided by many separate bodies.

Dr Marie-Anne Essam

70 years of medicine, free at the point of access, has inadvertently overemphasised the importance of what doctors can do, and has resulted in individual and organisational behaviours which need to change if we are to enable people, families, communities and nations to live their lives as well and fulfilled as possible.

People tend to have multiple obstacles to being well. There are historic and generational obstacles to personal freedom and quality of life. As a GP, I meet individuals and whole families who have often been unable to progress for years.

They often appear powerless, frustrated; have dysfunctional relationships, experience poor mental health, lack employment, stability and have a tendency towards health harming habits. Social Prescribing gives a fresh opportunity to find a way out of these negative and toxic mind-sets, behaviours and circumstances.

When meeting with these individuals and families, the first wider health factor that becomes apparent could be housing, neighbours, debt, isolation, poor physical fitness affecting long term conditions, stress related to their role as a carer, or poor mental health often not given a definitive diagnosis by psychiatry.

Someone with a long term health condition may be unable to change detrimental lifestyle habits, despite doctors’ advice and even referrals.

As a GP, whilst I may recognise these problems, I am not best equipped to deal with them. I don’t have the expertise, resources or time needed.

Much effort has been previously exerted by staff kindly phoning around, trying to help in a crisis, with varied success. However, there is no capacity to provide the appropriate follow through and support. Sometimes patients just come frequently to see a GP because non-medical issues, even hidden from view, are robbing them of being well.

I am constantly amazed and delighted by the changes I see when my patients return to me, very evidently more confident, proactive and happy in their own unique life contexts.

Link Workers

Let me introduce you to the Link Worker: They have the time, the expertise and the resources which my patients need to find the personal motivation, courage and strategy to improve their well-being.

By intuitive, non-judgmental listening, establishing trust and effective communication, the Link Worker provides what for some is the first opportunity to move from a very difficult and damaging place, to one where they are motivated and supported to make sustainable progress. A plan is co-produced in the context of this mentoring relationship according to the patient’s preferences and priorities.

Community groups, advice, programmes, key worker schemes, advocacy, creativity, activity, connections and counselling are just some of the options which might be included.

The Link Worker will, where needed, attend groups or meetings with the patient, using their time as seems most effective. Sometimes attending hospital appointments or benefits assessments catalyses the necessary change process.

Typically, that first conversation with the Link Worker lasts 60-90 minutes, often in the patient’s own home. As trust is established, 'What matters most' to the individual is understood and an action plan is devised together.

The Link Worker commits to contact and support for the next 3-6 months, occasionally longer, with maybe 12 contact points in that time, to help the person find their confidence, motivation, and ability to connect with and make best use of the solutions found. So where someone has previously failed to see something through, or been unable to navigate their way to suitable help, the Link Worker makes that vital difference.

So the Link Worker straddles the divide between the medical world, in which I am best trained and equipped, and all the other necessary help, furnished through a kaleidoscope of community-based assets.

I am constantly amazed and delighted by the changes I see when my patients return to me, very evidently more confident, proactive and happy in their own unique life contexts.

Here are two examples of patient stories that I have personally encountered - just a couple of the emerging testimonies of the benefits of Social Prescribing:

Patient 1

A man in his forties, long-term unemployed, living in a damp and derelict flat who admitted to me his 10 year old weekend-visitor son was getting embarrassed about coming.

The Link Worker was able to help him resolve the housing issues, he then worked as a community leader in the whole block of flats as he championed the resolution of the damp on the outside. His relationship with his son and his entire neighbourhood were marked with dignity and enjoyment.

The Link Worker encouraged him to take up a part-time cleaning job, early in the mornings. Within a few months rather than getting away swiftly at the end of his shift, he made friends with those working there.

At the start of the story, this man had a presumed diagnosis of Anti-Social Personality Disorder, and a cannabis habit. Sincerely, his psycho social health is now sound, and he gave up cannabis half way through the story.

The outlook for this man’s son is also different, as he is proud of the way his father has overcome longstanding difficulties and changed the environment around them both.

Patient 2

A lady who I had known for years would never let me in beyond the “I’m fine”, despite an obviously anxious and fearful body language. After an unplanned time off work with a musculoskeletal problem, she became more anxious, and admitted that work was the only place she could at least act happy and productive.

Her personal life consisted of shutting herself indoors, not answering the door or phone, not opening her post. No one else knew this. It took a few attempts to get her together with the Link Worker, but once I had got them both to attend her consultation with me, trust began to build. That pile of envelopes included an eviction order.

After some swift advocacy, work with the Citizens Advice Bureau, and the attendance of the Link Worker with the patient to court, the situation was resolved.

The CAB still provide a backstop support in case the old habits return, and my lady is not anxious anymore: the secret life of shame and fear which controlled her behaviours has gone - hopefully forever.

The principle of Social Prescribing is now recognised and promoted by the NHS as a key part of the Long Term Plan; specifically hosted by the Personalised Care Team.

A Link Worker will be available to every Primary Care Network from July this year (2019), and the guidance for Primary Care Networks will probably be released in May.

I was informally awarded the title as ‘Godmother of Social Prescribing’ a few years ago when I realised I need to spend the rest of my working career promoting and supporting the work.

Education for these new workers will be provided by NHS England; who will also undertake for regular Continuing Professional Development (CPD) updates. The best use of this team member will be to align them with Link Worker Schemes already nearby, so they are networked with peers, and enabled to build local bridges with the community groups and problem-solving opportunities available. They should become an integral part of both the clinical teams, and the resources around the practices.

The Link Workers will become part of practice Multi- Disciplinary Teams, and act as advocates and “connectors” to ensure that personalised care is integrated and as successful as possible. These colleagues will help the whole system use its resources more effectively, and promote community development.

Social Prescribing marks a culture change in our society. This is vital as the relationship between the State and the individual is also undergoing reforms. Our community agencies need our commitment and support as a society, so that there is the capacity, the sustainability, the resourcefulness and the robustness critical to meet individual and local population needs.

Social Prescribing helps us all close the gap between the help available and those needing it most. It leverages social mobility, addresses inequality in constructive and innovative ways and it shines a spotlight on the initiatives which are urgently requiring the investment of public and private funds. Social Prescribing is the most transformative initiative I have ever been a part of - and I do not apologise for being passionate about it. I have been involved in its design and development with colleagues right across the public and community sector.

I work as an ambassador for Social Prescribing in a number of arenas, which includes work with a Primary Care organisation in Ontario, Canada, and I support some national organisations here in the UK furthering the excellence and governance of Social Prescribing.

Recently, I was thrilled to speak to medical students who are members of the National Social Prescribing Champion Schemeand who are working to get Social Prescribing onto every medical school curriculum.

This is the substance of better health in our nation, and others, as we acknowledge that our health is not defined by our medical diagnoses, and that there are pathways close by us in solution-building communities to fulfilment of personal potential: when we realise that what our patients need most is a hope and a future.