UK: Social prescribing on the NHS (and possible implications for ME/CFS services)

@Invisible Woman

Personally, I've believed for the last few years that one major aim of the Powers-That-Be (PTB) is to kill off the poor and old, and the poor and chronically sick earlier than they would otherwise die - and doctors have to be brought onboard with that, otherwise they might start treating people who are the wastes of space, the useless eaters, the oxygen wasters the PTB believe the poor and the old and the sick are. The PTB have been producing propaganda about malingering and fraud for how long? Since Mrs T came to power? And it would appear that many doctors are no more immune against propaganda than the rest of the population. I also don't believe that doctors have any more insight into what is happening than the rest of the population (although there are probably many exceptions to that statement). I think the fact that GPs have been thrown under the bus has only become apparent to many of them in the last 10 years or so.

 

We told you you didn't have cancer ten years ago why do you still not believe us?

 

Universal Personalised Care: Implementing the Comprehensive Model
NHS England
31 January 2019

 

One thing I've noticed as someone with ME is that lack of insight many health professionals seem to have regarding the limits of their knowledge. On top of that they don't respect my knowledge. This includes GP's, therapists and consultants.

They seem very unwilling to say "I don't know". Not even a willingness to refer to someone who does, or may know, without a battle. They don't even seem to know what they don't know.

GP's seem to follow what I call the 3 visits / one year rule when if the problem is still ongoing after the later of these two they may take the M.E. patient seriously.

The doctor with the most most expertise in ME, that I have seen, was the most aware of what he doesn't know.

GPwSI were supposed to save money. But locally at least they ended up being more expensive than a consultant, whilst delivering a very limited service of diagnosis only.

Social prescribing seems to me to have the potential to be an expensive and wasteful experiment. Is there any evidence of SP working effectively anywhere else?

 

Have they thought of nurse practitioners? These nurses have extra training, and can work with the more minor consults.


Trouble is with all of this, how are GPs and the helpers always going to be certain it's a minor concern.

Yonks ago knew a teenager who died from some seemingly flu-like infection. Her doctor had been consulted twice. Twice he said it was the flu.

Nope...

 

Another thing about pushing people off into community support: is it available?

Does this mean yet again, volunteer groups?

Volunteer groups are struggling to find volunteers.

Governments often come out with this stuff - community involvement, local support etc.

On the face of it, it makes governments look good, because they can say there are resources, when there aren't any.

It's often not there, or over burdened and operating on a shoe-string.

 

From a quote included by @Sarah #37 above.

What the f*** does that mean? Just meaningless jumble of words. No wonder the NHS is going to hell in a hand basket.

 

I remember care in the community, in the UK, started at some point in the 1980s. They shut most of the mental hospitals and released everyone they could, claiming that support would be provided. It wasn't, or not enough, and now it's virtually non existent. These people still exist, left to deal with the DWP by themselves. Left as homeless or to fill prisons.

I'm not saying that that asylums were a good thing, they weren't, but that government attempts to cut costs by introducing new tiers of healthcare don't work, mainly because they won't actually pay for them on an ongoing basis once they find out what the costs actually are.

 

It sounds like the people in charge studied business, not medicine.

 

This definitely reads like the kind of stuff you could find in the sink of a MBA end-of-semester party. Just throw (up) random buzzwords and you too can make a killing!

 

What I think it means that Commissioner's (who purchase care) should encourage Providers (who Commissioners pay to deliver care, and include CICs and private sector) to set up services to deliver social prescribing. Commissioners agree to pay £x per annum and it is then up to the Provider to deliver even if there are unanticipated extra costs.

Problems arise when there is only one Provider who abuse their market position, and / or when there are inadequate quality monitoring mechanisms further compounded if there are also inadequate sanctions for poor performance.

If things go wrong it can be impossible to sort out as neither side have incentives to admit it's all a mess. In the meantime the patient gets a crap service.

ETA: the last two paragraphs are my views on some of the weakness of this split between Commissioning and Provider.

ETA 2: Further complexity and the opportunity for things to go wrong can arise when CCG's commission jointly from the same provider. Patients from "A" CCG area may think that because their care is from the "Unicorn Provider" they are getting the same care as "B" CCG area.

But no, the CCG's may have different contracts with Unicorn which provide for different levels of care. The different CCG's may have different views as to the definitions of what is to be delivered. To use a M.E. example, a ME/CFS Clinic may be CF for one CCG, CFS for another and M.E. for a third. But Unicorn call themselves a ME/CFS Clinic. There are clinics within clinics, all provided by the same therapists.

Pinning down accountability becomes increasingly difficult.

 

I saw a graph of this once with two curves. One curve was the number of people in mental hospitals, the other the number in prisons, versus time. As the first went down (due to the care in the community policy), the second went up to match.

 

It means money that could be spent on frontline NHS services will instead go to some private contractor, boosting the profits of their shareholders. At least that's how I see it.

 

If you worry about the quality of the heath service you have resigned from greener practice and found something more consistent with self-respect.

 

I think either is acceptable.

stupendous stupidity.

At least they are being honest, unlike the physicians who think it but don't say it.

 

Merged thread

Blog: Local Democracy and Health, "The NHS Long Term Plan and Social Prescribing"

https://localdemocracyandhealth.com/2019/01/30/the-nhs-long-term-plan-and-social-prescribing/

 

Social Prescribing seems to be taking off in a big way the RCof Psych just had a conference on it

https://twitter.com/user/status/1138733707114745856


https://twitter.com/user/status/1138737197799084032



see other tweets at #SocialPrescribing

 

Sorry to be thick, but what is 'Social Prescribing'? I scanned the article in the OP but I'm very foggy, i couldn't grasp most of it & it didnt appear to explain what it actually is anywhere.
uh, i'm too ill for this, will come back another time when my brain functioning better

 

As far as I can understand what social prescribing is is that someone with a few hours training can prescribe certain drugs, or treatments, without the involvement of someone who has been medically trained to do such things.

We don't have enough doctors you see, they keep leaving for less hostile/stressful environments, like Syria, as soon as we train new ones up.

So someone's got to deal with all the patients.

Of course I am hopefully wrong but that's the impression I've got in the last few months.