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.
 

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

The Comprehensive Model for Personalised Care has been co-produced with people with lived experience and a wide range of stakeholders and brings together six evidence-based and inter-linked components, each of which is defined by a standard, replicable delivery model.

The components are:

1. Shared decision making
2. Personalised care and support planning
3. Enabling choice, including legal rights to choice
4. Social prescribing and community-based support
5. Supported self-management 6. Personal health budgets and integrated personal budgets.
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Social prescribing and community-based support:

Enables all local agencies to refer people to a ‘link worker’54 to connect them into community-based support, building on what matters to the person as identified through shared decision making / personalised care and support planning, and making the most of community and informal support.


Design principles:

A local social prescribing scheme must:

1. Be appropriately funded and supported by local partnerships of commissioners and primary care networks.

2. Receive referrals from all local agencies, including General Practice.

3. Involve a one-stop social prescribing connector service, typically located in primary care, which employs link workers to give people time and personalised support, connecting them to community support, based on what matters to the person

4. Connect people to community groups and voluntary organisations that are supported to receive referrals.

5. Put in place operational protocols about expected priority groups, expected numbers of referrals, workforce, costs, and effectiveness.

6. Have access to a range of community-based approaches providing peer support, advice, increased activity and access to community-based support.55


Standard model:

• Social prescribing connector schemes are commissioned collaboratively, with primary care networks, local authorities, CCGs, other local agencies, the voluntary and community sector and people with lived experience all working together.
• There is a clear and easy referral process from GPs, GP practices and other channels, to social prescribing link workers. Self-referral is also supported.
• Link workers are typically located in primary care through primary care networks, as part of a wider network team.
• Link workers receive accredited training and ongoing development to support their role.
• Link workers give people time and start with ‘what matters to you?’ They coproduce a simple plan or a summary personalised care and support plan as per the standard model (see above), based on the person’s assets, needs and preferences.
• There are up to five link workers per primary care network, supporting up to 3% of the local population, or around one full-time equivalent link worker per 10,000 local population.
• Link workers work with people on average over 6-12 contacts, and hold a caseload of a minimum of 200-250 people per year.
Local areas should have: • A clear understanding and map of existing communities, community assets, high impact interventions and gaps.
• A whole-system strategy to develop community-based approaches.

If social prescribing and community-based support is delivered according to this standard model, our indicative expectation is:

• 100% of GPs and GP practices are able to involve link workers in practice meetings and making referrals to them.
• 90% of link workers have received accredited training and feel confident in carrying out their role.
• 80% of people take up their social prescription after referral
• There is a positive impact on GP consultations and A&E attendances and wellbeing for those referred, achieving:
- 14% fewer GP appointments
- 12% fewer A&E attendances.
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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.
 
6. Commissioners should nurture nascent markets through risk-sharing agreements. The nature of these agreements should vary by market maturity, but be designed for providers ultimately to assume full financial responsibility for patient care.
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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.
 
ladycatlover said:
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.
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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.
 
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Wonko said:
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.
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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.
 
In the UK community centres that provided youth clubs spaces for keep fit pensioners groups erc which have been funded by local authorities as community/social service have been slashed. Because health funding has a higher status and a bit harder to slash to the same extent it makes sense for providers to try to rebrand this type of activity as about mental and physical health to stand a somewhat better chance of getting funding. Because there are gaps in these areas it can be presented as innovative new services. The problem from the health service perspective is this puts yet further demand onto funding and takes money out of core services for people with medical problems and clinical level mental illness.
 
Merged thread

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

I think this means that by 2023/4 900,000 people a year will be offered Social Prescribing by the NHS. Note the commitment to 1,000 social prescribing link workers. I have allocated them by population size of CCG so for example Sheffield get 10 and Corby 1 (my full CCG list is here) of course doing it this way takes no account of inequality. The statement about NHS Social Prescribing Link workers has generated anxiety in the voluntary sector who are the main providers currently – with concern that these will be NHS employees.

At the moment there are about 59.7 million patients registered with GPs who make over 240 million appointments a year. compared to the 900,000 a year promised for Social Prescribing. This means that in 5 years time social prescribing activity will be equivalent to .38% of appointments at GPs. Here is an illustration of the scale of this.
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https://localdemocracyandhealth.com/2019/01/30/the-nhs-long-term-plan-and-social-prescribing/
 
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Social Prescribing seems to be taking off in a big way the RCof Psych just had a conference on it






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.
 
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