Personalised Care through Social Prescription

The current buzz word is ‘Social Prescribing’ – but what is it? And how can nurses become more involved?

According to NHS England (2019), social prescribing is a non-medical approach that uses asset-based approaches to encourage us to ask, ‘what matters to a person’ rather than ‘what is the matter with a person’. As a salutogenic approach, it ensures that the wellbeing of individuals is considered and has been advocated as part of the NHS England Comprehensive Model of Personalised Care.

As nurses, we may be more familiar with the ‘ABCD’ approach, and you may have used ‘community referral’ as a method to support self-care and self-management. However, within the social prescribing context, a ‘link worker’ or ‘community connector’ is responsible for engaging individuals through a wellbeing conversation and referral to a relevant non-medical, asset-based service that can best support the person.

According to the NHS England Long Term Plan, there will be a link worker in every GP practice by 2020. Typically, a link worker will be employed by the GP practice or a third sector organisation to support the wellbeing of a person and ensure that they are assessed and referred to an appropriate non-medical service.

Currently, it is estimated that 30% of visits to the GP are unnecessary and are caused by wider social influences; hence, using a personalised approach to support social prescription can help ensure that the individual is supported by the right person and/or service. This is different from the medical or pathogenic model, as the focus of the wellbeing conversation is to identify what matters to the individual and co-create a ‘social prescription’ that meets those needs.

For example, a pathogenic model may influence a health professional to prescribe anti-depressants to reduce a person’s depression. This presents a needs-based, rather than a strengths-based approach in an attempt to find a solution to the depression.  Using a personalised care approach helps to understand what matters to the individual in order to ‘prescribe’ or determine the most personalised recommendation.

A wellbeing conversation between the individual and the link worker may elicit that the person’s anxiety and depression has been influenced through being socially isolated. Research suggests that social isolation has the equivalent detriment on health as smoking 15 cigarettes a day and can also be the cause of depression.

Through engaging with the person, the link worker (or other front line individual) may discover that the person enjoys gardening – and may, therefore, benefit from joining a gardening group through the National Garden Scheme or other nature-based interventions such as community allotment groups, and/or care farms.

Nature-based activities have been defined as ‘an intervention with the aim to treat, hasten recovery, and/or rehabilitate patients with a disease or a condition of ill health, with the fundamental principle that the therapy involves plants, natural materials, and/or outdoor environment, without any therapeutic involvement of extra-human mammals or other living creatures’ (Annerstedt & Währborg 2011).

The value of nature-based interventions is well known: there is a positive impact on health, mental wellbeing and, importantly, reduced social isolation. There are some useful resources on the Natural England website.

Other research reports a direct link between exposure to, and involvement with, nature and improved health and wellbeing for communities and individuals. Referral through a social prescription to a nature-based intervention may have positive impact on the social wellbeing of the person, their physical activity and a reduction in symptoms of depression.

Arguably, as nurses, whilst we have used non-medical approaches to promote wellbeing, there has been a predilection with the medical model resulting in an unbalanced paradigm based on a pathogenic rather than salutogenic approach. However, with the surge of interest in social prescribing – particularly in terms of how it can promote personalised care, there seems to be a steady paradigm shift in the philosophy of nurse education placements across the sector.

Higher Education Institutions are currently engaging with the new NMC Standards for Pre-Registration Nursing and creating innovative ways to expose students to a range of socially prescribed services that use personalised approaches. This includes many organisations within the voluntary, community and social enterprise sector that offer support ranging from the Arts, through to nature-based opportunities that utilise local assets predicated on the person’s interests.

The NHS Comprehensive Model of Personalised Care challenges organisations and front line professionals to think differently about communities and individuals. Now is a time for a change and an opportunity to make a difference in people’s lives in a meaningful and personalised way.

So what do nurses need to do next? Why not find out more about how nursing is influencing the personalised care and social prescribing agenda and join the Social Prescribing Network Nursing Special Interest Group Twitter – @SigSpn.

To find out more about how Personalised Care is influencing services and professionals, visit these websites:

• NHS England – Personalised Care
• The National Social Prescribing Network
• National Link Worker Network.

 Dr Michelle Howarth

Senior Lecturer/Deputy Director PGR – progression and training. Research Lead (Health Directorate) School of Health & Society, University of Salford.

Email: m.l.howarth2@salford.ac.uk

Twitter: @Howarth2L

Gardens and Health Week takes place 11-19 May 2019. Visit the National Garden Scheme website to find out more.

Photo by Erda Estremera on Unsplash.