"Social Prescribing in Palliative and End of Life Care 

Can it make a difference?"

What is social prescribing?

Currently there is no agreement on a definition but the Social Prescribing Network (2016) refer to Social Prescribing as a concept that enables healthcare professionals to refer patients to a link worker, to co-produce and design a non-clinical social prescription to improve their health and well being. The Welsh NHS Confederation (2017), helpfully state that the literature is broad and diverse in its scope for Social Prescribing but advocates the term includes any interaction or intervention that promotes self-care and well-being, encourages social inclusion and as a result, builds resilience for individuals and communities.  

Social Prescribing is based on a clear set of values which are about harnessing existing community assets to achieve well-being. It is about communities coming together for positive change and tapping into skills, knowledge, interests and lived experiences on the issues they encounter in their everyday lives. 

Social Prescribing aims to change the relationship between the patient and the practitioner, it requires a collaborative exploration of options available in order to improve and maintain well being. The concept sets out to make available new life opportunities for those most in need, through forging new relationships and promoting independence. Examples include choirs, book clubs, man sheds, and exercise classes in order to improve physical and mental health. 

Social prescribing is about expanding the range of options available to patients and professionals, promoting new perspectives and driving innovation. Social Prescribing is a concept that treats the patient and not the illness.

Studies consistently report that along with physical illness, the majority of patients who attend GP appointments frequently suffer mental health problems, emotional distress and/or social difficulties (Vedsted and Christensen, 2005, Gill and Sharpe, 1999). Therefore, not every patient seen by a GP needs the expertise of a doctor. In a study conducted by The Primary Care Foundation and NHS Alliance (2015) entitled Making Time in General Practice, twenty seven percent of all GP consultations were identified as being potentially avoidable. This is thought to be due to lack of coordinated working between primary and secondary care, not appropriately using primary care staff, inadequate use of technology to tackle administrative burdens, and the need to embrace wider system changes. 

There is a building body of evidence that GPs should be supporting and empowering patients to manage their own well-being and this as a consequence will reduce the demand on primary care services. The Primary Care Foundation and NHS Alliance (2015) in their report, identified a number of practical, high-impact ways to remove unnecessary pressures on general practice and free up time for patient care (Figure 1). There is an expectation for GPs to adopt these 10 High impact actions (one of which is Social Prescribing) in the hope of releasing more time to care through attending Learning events and seminars and identifying champions in the workplace. It is anticipated that General Practice will report on implementation of these high impact actions.

Figure 1: 10 High Impact Actions to Release Time for Care

1. Active Signposting
2. New Consultation Types
3. Reduce DNA's
4. Develop the team
5. Productive work flows
6. Personal productivity
7. Partnership working
8. Social Prescribing
9. Support self care
10. Develop QI expertise

The link between recreation and well being is not new. 

Walt Disney (1958) writing in The Journal of the American Medical Association stated that he had a close association with healthcare. He described his work as “prescriptions for pleasure”, and goes on in describing that fun and play has a tonic effect and is widely recognised as a treatment for stress, worry and the trials of everyday living.

Kimberlee (2014) advocates that Social Prescribing helps to tackle the lower levels of well-being experienced by those with psychological problems and hopes that there will be a positive impact on frequent attendance in primary care. The Kings Fund (2018) state that a design principle for future models of community-based care should take a ‘whole-person’ approach, addressing people’s physical health, mental health and social needs together. These factors are often closely related and interact to influence health and well being. Even people with long term conditions, who tend to be heavy users of the health service, are likely to spend less than 1% of their time in contact with health professionals. The rest of the time they, their carers and their families manage on their own (NHS England, 2015) and continue by confirming that personalised care will only happen when statutory services recognise that patients’ own life goals are what count; that services need to support families, carers and communities; that promoting well being and independence need to be the key outcomes of care. 

The Kings Fund (2018) have recently released a Call to action in relation to “Re-imagining community services”. The aim and ambition of this document is to strengthen community services that have yet to be realised. Interestingly, throughout the literature there is an emphasis and subsequent expectation that service providers need to look to deliver services in different ways instead of carrying on and delivering in the same way (The Welsh NHS Confed, 2017, NHS England, 2015, The Kings Fund, 2018). The Kings Fund (2018) states that the five year forward plan, explicitly sets out a vision of how NHS services need to evolve in order to meet the future needs and demands of the population. It makes the case for greater prominence on prevention, integration and empowering patients and communities to take control of their own health needs. It also called for a shift in investment from acute care to primary and community services. 

Therefore, the question posed is can social prescribing make a difference in palliative and end of life care?