GPs referred hundreds of thousands of patients to new ‘social prescribing’ services to tackle loneliness or to boost wellbeing during the pandemic – but one in five turned down the offer.
Social prescribing takes a holistic approach to patient wellbeing, linking patients with a wide range of services to help address mental health, loneliness or improve their lives without medical intervention.
It is a key part of the NHS long term plan – but analysis by NationalWorld suggests the initiative may not be proving as popular with patients as hoped.
NHS Digital figures reveal 407,117 patients were referred during 2020/21, with 556,751 individual referrals between them.
But 101,704 patients were recorded as having declined a referral - suggesting one in five patients (20%) turned down non-clinical support.
Vast regional discrepancies emerged in the data.
Patients in the North East had the best access to social prescribing activities.
In comparison, patients in the South West were much less likely to encounter the same services.
What is social prescribing?
Social prescribing takes a ‘holistic approach’ to people’s health and wellbeing.
It benefits people with long-term conditions, people needing mental health support, those who are lonely, and those who have social needs.
A social prescribing link worker connects people with community activities and services to make improvements to the individual’s life, assisting people that do not necessarily require clinical treatment.
Patients can benefit from a wide range of activities from benefits advice, housing help, singing and cooking classes, to sports and gardening.
How can social prescribing help people?
Dr David Smart is a retired GP of 30 years and is now one of the leads behind a green wellbeing programme in Northampton at historic Delapre Abbey.
The nature-based programme launched in October, after receiving £50,000 from the Arts Councils’ Thriving Communities Fund to better enhance wellbeing after Covid.
He said: “The term we use is ‘green social prescribing’, which simply means supporting people to improve their health and wellbeing by engaging in nature-based activities such as walking, cycling, photography, art, community gardening and food-growing projects.
“Being outside in green space helps our wellbeing especially if we stop and notice what is around us.”
The programme hopes to reach and improve the health of up to 3,000 people through reducing the need for medical support and intervention.
He added: “This is the opportunity to be transformational – to get people linked up to the voluntary sector. It’s not beneficial for GPs to be dealing with low wellbeing. Antidepressants only work if you have severe depression, that’s NICE guidance.
“Doctors can’t deal with debt issues, housing and lifestyles in truth - these are issues that can be dealt with by community resources and community teams.”
Highest demand during pandemic
The highest number of referrals came between January and March 2021.
GPs referred 163,313 people, which made up 40% of the annual figures.
At this time the country had entered national lockdown restrictions for the third time on 6 January before a phased exit on 8 March.
The second highest number of referrals was between April and June 2020 – showing referrals peaked during the most intense lockdown periods.
Which areas in the UK referred the most patients?
The North East saw the greatest activity, with 877 patients referred per 100,000 people.
The South West had the fewest people referred, at 400 per 100,000.
But use of the referrals varied widely.
This could be because GP practices or primary care networks do not have a social prescriber link worker role in place yet.
In the Bury Clinical Commissioning Group (CCG) area only 20 people were referred per 100,000, while 2,371 per 100,000 people were referred in the NHS Warrington CCG area. No patients were referred by Shropshire, Telford and Wrekin CCG GPs.
900,000 referrals by 2023/24
GPs made a record number of referrals to social prescribing services in 2020/21.
Figures were up 804%, with only 61,619 referrals recorded in 2019/20, the first year in which social prescription data was collected.
However, a financial incentive for surgeries to record referrals was introduced by the NHS in 2020/21, so this could in part reflect an improvement in recording rather than a rise in referrals.
The financial reward is given to the surgery’s primary care network to recruit link workers, who carry out social prescribing services.
There are 1,250 primary care networks across England, which connect groups of GP practices together to build on existing care services.
Instead of providing reactive doctors appointments, primary care networks look at proactively caring for the people and communities they serve.
The NHS wanted 1,000 new social prescribing link workers in place by 2020/21 as part of its Long Term plan.
NationalWorld has identified that there are fewer than five staff recorded under this job title on their staff records, according to NHS Digita datal. NHS England has not confirmed if there are more, or if the target was met.
The NHS Digital figures show that 458,197 patients have been referred by a GP to social prescription services since April 2019, although patients referred in both 2019/20 and 2020/21 would be counted twice.
The NHS long term plan states that it wants 900,000 people to be referred by 2023/24.
NHS England did not respond to a request for comment.
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