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What is social prescribing? “a means of enabling GPs and other frontline healthcare professionals to refer to ‘services’ in their
community instead of offering medicalised solutions” (NHS England, 2018)
Care navigator/link worker develops tailored plans and connects to local groups and support services
Recognises a person’s health is heavily determined by economic, social and environmental factors
Holistic approach, supporting the individual to take control of their overall health and wellbeing
Welcome to our February bulletin where we focus on social prescribing evidence. As it is rolled out across primary care, what evidence is there for social prescribing, its implementation and outcomes, and what future research and evaluation is needed?
Bulletin Research and Evidence NECS Research
and Evidence Team
February 2020 Contact the Team
@NECSRETeam
0191 217 2528 (switchboard)
https://www.necsu.nhs.uk/research-evidence/
Social prescribing: The evidence “the evidence base for social prescribing currently lags considerably behind practice” (Husk et al., 2019)
The evidence so far…
Public Health England, 2019
Evidence synthesis
8 UK studies of low methodological quality - no clear evidence for effectiveness
Studies focusing on primary care outcomes inhibited by data quality - inconsistent/incomplete recording & discrepancies
Difficulty comparing studies due to variation in type & level of support provided e.g. signposting vs. accompanying to activities
Husk et al., 2019
Realist review – 1) evidence-based theories about social prescribing developed 2) processes clarified using evidence
Enrolment more likely if individuals believe it will benefit, referral presented in an acceptable way & concerns addressed
Engagement more likely if the activity is accessible & transit to the first session supported
Adherence more likely if activity leader knowledgeable and skilled & changes in condition/symptoms observed
Bickerdike et al., 2017
Systematic review of 15 social prescribing evaluations
“clear methodological shortcomings”; lack of standardised/validated measuring tools & comparative controls.
Polley et al., 2017
Systematic search and summary of 14 papers
Following referral, 28% reduction in demand for GP service (7 papers) & 24% fall in A&E attendance(5 papers)
No traditional cost-effectiveness analysis (8 papers) & higher costs per patient in intervention group of RCT
mean social return on investment (SROI) £2.3 per £1 invested (4 papers)
evidence supports potential for social prescribing to reduce demand & deliver cost savings – however quality is weak
Moffat et al., 2017
Qualitative study of service user perspectives
Positive impact on health related behaviours e.g. healthy eating, weight loss, increased physical activity
Reduced social isolation, increased self-confidence & control
Loftus et al., 2017
Contacts with GP & new repeat prescriptions measured before & during social prescribing intervention
No statistically significant difference in attendance at GP practice or home visits
No significant difference in repeat prescriptions at 12 week or 6-12 month follow up
Looking for examples? Check out the research & evaluation resources shared by the Social Prescribing Network
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Evidence on the role of the care navigator/link worker
NHS England/Improvement guides in 2019, included:
Social prescribing and community-based support: Summary guide – example job description in Annex A
Social prescribing link workers: Reference guide for PCNs
Induction guide for social prescribing link workers in PCNs
Wildman et al., 2019
Link workers of the utmost importance
Should be remunerated as such, with appropriate career development
Complicated role – with complex patient needs
Challenges – speed of referral & availability of community groups/organisations
Tierney et al., 2019
75 different titles for ‘care navigator’
Commonly an upskilled, existing member of general practice staff
What evidence is needed? Studies that help understand social prescribing implementation - the link worker role, services provided &
patient’s engagement with services
More high-quality research & evaluation addressing effectiveness – including RCTs
Greater consistency in data collection and reporting
Why build in evaluation? Evaluate need & plan – What evidence already exists to help us prioritise? Who has what social prescribing needs (referral criteria & service spec)? Can we measure a baseline? What evidence is missing? What do we need to gather?
Evaluate process – how is social prescribing being implemented? Who is participating? To what extent are stakeholders satisfied? Are targets being achieved? What works well? What needs to improve?
Evaluate outcomes – do indicators demonstrate things have changed at key milestones e.g. individual wellbeing, CVS capacity, # of GP consultations? Were there any unexpected/unintended changes? What have we learned?
Evaluate impacts – when social prescribing is embedded (1 year+), what overall difference does it make to people, community groups and the health & care system? What has improved, how & at what cost? What have we learned?
What guidance is there for evaluation?
A draft framework of common outputs, outcomes and impacts outlined in Annex D of the NHSE/I Summary guide
An NHSE/I guide to the recommended Patient Activation Measure (PAM) – this requires a license & draft framework states other wellbeing measures also being explored
Public Health England (PHE) & the York Health Economics Consortium (YHEC) have developed a return on investment (ROI) tool to measure value of interventions for older adults to NHS, social care & society
PHE have also published guidance on developing behaviour change interventions based on behavioural & social science
The National Lottery Community Fund have published voluntary & community sector (VCS) social prescribing examples & insights, and a quality assurance guide
The think-tank New Philanthropy Capital has published a guide to understanding and evaluating impact for the VCS
The most recent BMJ clinical update on social prescribing is available via OpenAthens
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Check out: @NIHRCRN_NENCumb & @TinkleLin Tweetchat - 24/02 #ResearchNENC
Upcoming Training NECS Research and Evidence Training The NECS Research & Evidence Team deliver training sessions on a range of topics including strengths and weaknesses of different types of evidence, how to access research papers using a search strategy, how to critically appraise evidence and how to design and complete an evaluation project
These sessions can be attended by any NECS, CCG and Primary Care staff. Training is free, but places are limited so must be booked in advance. To reserve a place please book direct via the NECS Learning website https://learning.necsu.nhs.uk/upcoming-events/. Details of sessions are below.
At Hambleton, Richmond & Whitby CCG, Civic Centre, Stonecross, Northallerton, DL6 2UU:
Appraising evidence, Tuesday 17th March, 9.30-11.30am
Designing & carrying out evaluations, Monday 20th April, 9.30-11.30am
In the Boardroom, Riverside House 2nd Floor, Newburn, Newcastle, NE15 8NY:
An Introduction to Research and Evidence, Thursday 23rd April, 9.30 – 11.30 am
Finding evidence, Wednesday 6th May, 9.30 – 11.30 am
Appraising evidence, Tuesday 9th June, 9.30 – 11.30 am
Designing & carrying out evaluations, Wednesday 8th July, 9.30 – 11.30 am
Research & Evidence full day training, Wednesday 21st October, 9.00 am – 5.00 pm (combines all the sessions above)
New research
Are you using or developing digital health products?
Public Health England have published new resources to assist with digital health product evaluation including step-by-step guides and a methods library.
Recently published…
Health Equity in England: The Marmot Review 10 Years On (February 2020) This report by the Institute of Health Equity, provides analysis of health inequalities in England and assesses changes in key social determinants of health in the last 10 years. It sets out an agenda for local and national government to reduce health inequalities based on evidence and practical examples.
How to build effective teams in general practice (January 2020) A guide from the Kings Fund which draws together research, policy and leadership insights to help professionals working in primary care think about how to create and sustain effective teams in the context of primary care networks, multi-agency and multidisciplinary team working.
Unconventional health and care: five organisations delivering care differently (December 2019) The Kings Fund present case studies of organisations adopting unconventional practices which have demonstrated success in coping with increasing demand, delivering compassionate care and supporting people with complex needs and considers how these approaches can be used more broadly.
Achieving Integrated Care: 15 best practice actions (September 2019) This report from the Local Government Association and Social Care Institute for Excellence proposes practical actions to support integration of local systems. The actions - based on evidence, stakeholder engagement, national policy and guidance - aim to allow local variation in system design/service delivery.
Our communications
We are reviewing our communications, and as such there will be no bulletin in March. If you have any comments or suggestions for what/how we should communicate in future, please let us know at [email protected].
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Message from the ARC
NIHR Applied Research Collaboration North East & North Cumbria
Open Funding Competition 2020 To achieve our vision of ‘Better, fairer health and care at all ages and in all places’, the NIHR ARC NENC is pleased to invite original and high quality research proposals focussed upon regional health and care priorities. These should aim to improve health and social care outcomes in those communities and sectors facing the greatest challenges and generate original research outputs.
We welcome applications from a wide range of collaborations which include individuals working in universities, NHS and social care providers, local authorities, charities, voluntary sector organisations and businesses. All proposals must include university representative from a relevant ARC theme and a representative from another organisation category, but any partner can lead the application.
A maximum of £100,000 over 2 years will be available for exceptional projects, but it is expected that costs for most proposals will be lower and all will be scrutinised for value. Matched funding is encouraged. Proposals must be formally costed and agreed by a responsible finance officer in the host organisation.
Proposals must be linked to an ARC NENC theme and include evidence of support from the relevant theme lead or deputy lead (if they are not already involved). The themes are listed below:
Multi-morbidity, Ageing and Frailty
Supporting Children and Families
Prevention, Early Intervention and Behaviour Change
Integrating Physical, Mental health and Social care
Inequalities and Marginalised Communities
Assistive Technologies and Data Linkage
Evaluating Change with Pace and Scale
Knowledge Mobilisation and Implementation Science
To register interest and receive the application documents, the lead applicant should submit their details here, including a potential title, collaborating organisations and a theme affiliation. The lead applicant must be connected to a relevant theme before the registering interest. If not, then please complete a simple membership form here.
If needed, the NIHR Research Design Service NENC will advise applicants who intend to use the output from an award to support an application to one of the main NIHR funding streams: https://rds-nenc.nihr.ac.uk/
The closing date for registrations is: 12pm on 13th March 2020. Proposals which are submitted without prior registration will not be processed. The closing data for submission of a proposal is: 12pm on 8th April 2020. Applicants will be informed of the outcome in late July / early August 2020. Projects must aim to start between 1st October 2020 and 31st December 2020. All projects will be expected to provide updates and a publicly available final report.
#1 Understanding sciatica: illness and treatment beliefs in a lumbar radicular pain population
#2 Enhanced hypertension care through private clinics in Pakistan: a cluster randomised trial
#3 Processing discharge summaries in general practice: a study with GPs and practice managers
#4 Prescribing trends of gabapentin, pregabalin, and oxycodone
#5 Long-term use of benzodiazepines and Z drugs: a qualitative study of possible levers for change
#6 Deprescribing proton pump inhibitors: a return to self-management through education and alginate rescue therapy
#7 Overseas GP recruitment: comparing international GP training with the UK
#8 Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care
#9 Frequent attenders: a consultation-level intervention to improve care of frequently attending patients
#10 A retrospective review of pain management in Tasmanian residential aged care facilities
BJGP Open - Top 10 papers of 2019
