{"id":4369,"date":"2020-01-16T15:38:41","date_gmt":"2020-01-16T15:38:41","guid":{"rendered":"https:\/\/randomthoughtsltd.com\/?p=4369"},"modified":"2024-04-03T14:13:29","modified_gmt":"2024-04-03T14:13:29","slug":"ive-seen-the-future-of-general-practice-and","status":"publish","type":"post","link":"https:\/\/randomthoughtsltd.com\/?p=4369","title":{"rendered":"I\u2019ve Seen the Future of General Practice, and . . ."},"content":{"rendered":"\n

First published in the NASGP Newsletter in October, 2019<\/em><\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Social prescribing transforms 21st<\/sup> century lives<\/strong><\/p>\n\n\n\n

A partner in a North\nLondon practice was feeling burned out. The crushing target-chasing workload\nwas no longer offset by the reward of helping patients. The BNF had no remedy for\nthe distresses of modern life which patients were bringing into her consulting\nroom. She, like her patients, was ground down.  <\/p>\n\n\n\n

Casting about for\na way of reviving the sense of hope and enthusiasm that had led her into\nmedicine, she contacted the local Transition Group. Three years later a bleak\ncourtyard next to the practice has transformed into The Listening Space \u2013 a\ntherapeutic garden where patients and staff get together. They have pitched in\nto create a beautiful and productive green space. People who no longer have gardens\nof their own share their expertise, patients help with planting and harvesting,\nand they cook for seasonal parties. Immigrants are delighted to share their\ntraditional dishes. Patients and staff demonstrate their music talents, and\neveryone chats.<\/p>\n\n\n\n

The \u2018Crafternoons\u2019 in the waiting room were slow to take off, but gradually patients plucked up the courage to join in, and now it\u2019s a flourishing social group. Lonely patients in the waiting room are encouraged to participate. While members embroidered \u2018welcome\u2019 onto fabrics in their native languages, an old man sat on the edge of the group staring at his hands. Suddenly he perked up, saying \u201cYou haven\u2019t got my language \u201d.  Offered blue thread, he insisted on red, gold and green, the colours of his birth nation\u2019s flag. He\u2019s now a regular, and for the first time, staff say, he\u2019s smiling.<\/p>\n\n\n\n

Hollowed-out social infrastructures have left us all less connected, and the most vulnerable people easily fall through the holes in the net. They crave worthwhile activities to occupy the long empty hours, to distract them from insoluble problems, to make them feel useful again. But people who are treading water need someone to help them onto firm ground. Medical prescribing for medical problems, social prescribing \u2013 referral to a range of local, non-clinical services \u2013 for social problems. It makes sense.<\/p>\n\n\n\n

Hollowed-out social infrastructures have left us all less connected, and the most vulnerable people easily fall through the holes in the net.<\/p><\/blockquote><\/figure>\n\n\n\n

In Somerset, Frome\nwas once a busy market town, but over the decades its life-blood drained away.\nBy 2013 the town was flat-lining. The residents were depressed. The GPs and\ntheir staff were disheartened and stressed because they couldn\u2019t solve health problems\nthat were essentially social in origin. Again, a GP took the initiative. She worked\nwith the town council and the local Compassionate Communities health group to\nidentify unmet social needs. Now GPs can refer patients to professional \u2018health\nconnectors\u2019 who bridge the gap between patients and community resources. As\nwell as practical advice, innovations include \u2018talking cafes\u2019, and – so isolated\nold men can potter in company – \u2018men\u2019s sheds\u2019.<\/p>\n\n\n\n

Six years on, the people\nof Frome, their town, the practice – all exude confidence. Patients feel they\nhave choices and are in more control of their lives and health. The attendance\nfigures demonstrate the benefits for the NHS. GP appointments are down 28% and A&E\nattendances 24%, while in Somerset towns comparable to Frome demands on the NHS\ncontinue to rise.  <\/p>\n\n\n\n

There\u2019s nothing\nlike a walk, the wilder the better, to blow away brooding thoughts. Studies\nshow that two hours a week in the fresh air is enough for people to feel\nbetter, more self-assertive. In the Shetlands, it was the RSPB\u2019s outreach\nofficer who suggested \u2018nature prescriptions\u2019. \nNow Shetland GPs \u2018prescribe\u2019 walks, with tips about what to look out for\nand do en route. Patients are more active, many lose weight, and their physical\nand mental health improves.  <\/p>\n\n\n\n

Talking groups,\nwalking groups, reading, drawing, sewing groups, gardening, cooking, singing:\nfor almost any activity there will be someone out there who is anxious to share\ntheir enthusiasm with other people. Even the housebound can join a world-wide\nvirtual choir. They sing their part and upload it onto the internet where it is\ncombined with everyone else\u2019s contribution. The resulting concert is streamed,\nalong with photos of the participants, so they all share the pleasure of\nsinging together. <\/p>\n\n\n\n

You don\u2019t have to\nbe a GP to set the ball rolling. In St Ives, a market town in Cambridgeshire,\nthe vicar, the mayor and a publican joined forces to rebuild their community. Because\npeople were concerned about the suicides of young men they packaged a bundle of\noutreach activities into, CALM \u2013 a \nCampaign Against Living Miserably.<\/p>\n\n\n\n

Westminster\ncouncil and many others offer elderly residents a surprising range of\nactivities. Initiatives like these are trying to reinvent communities. Whose\nresponsibility is that? <\/p>\n\n\n\n

Governments tend\nto try to initiate change through stultifying tick-box protocols or by publishing\na leaflet – passive dissemination – though the only thing that can be\nguaranteed to trickle down is rain through a hole in the roof. In its 2019 Long\nTerm Plan, NHS England promises \u2018an army\u2019 of 1000 link workers (that\u2019s one for\nevery seven practices) to kick-start social prescribing. But this is a vision\nnot a mechanism.<\/p>\n\n\n\n

Social prescribing\nis a transaction. Some patients will be delighted at the idea, but others,\nhoping for a miracle pill, may be dubious. Like a medical prescription, a\nsocial prescription will only be used if the patient has confidence in the\nprescriber. So, successful social prescribing still depends on the committment\nand vision of GPs.<\/p>\n\n\n\n

Beveridge\u2019s vision\nwas a welfare state to resolve the backlog of neglected medical problems of the\n1940s. The NHS did that job, and health services today are faced with a very\ndifferent challenge. Social prescribing transforms 21st<\/sup> century\nlives. And not just for patients. It meets so many modern needs that worn-out\nGPs can rediscover their zest for their job.<\/p>\n\n\n\n

I\u2019ve seen the\nfuture of general practice, and it works!<\/p>\n\n\n\n

With thanks to Dr Jane Myat of Caversham Group Practice<\/em><\/p>\n\n\n\n

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First published in the NASGP Newsletter in October, 2019 Social prescribing transforms 21st century lives A partner in a North London practice was feeling burned out. The crushing target-chasing workload was no longer offset by the reward of helping patients. The BNF had no remedy for the distresses of modern life which patients were bringing … <\/p>\n

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