I’ve Seen the Future of General Practice, and . . .

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 into her consulting room. She, like her patients, was ground down.  

Casting about for a way of reviving the sense of hope and enthusiasm that had led her into medicine, she contacted the local Transition Group. Three years later a bleak courtyard next to the practice has transformed into The Listening Space – a therapeutic garden where patients and staff get together. They have pitched in to create a beautiful and productive green space. People who no longer have gardens of their own share their expertise, patients help with planting and harvesting, and they cook for seasonal parties. Immigrants are delighted to share their traditional dishes. Patients and staff demonstrate their music talents, and everyone chats.

The ‘Crafternoons’ in the waiting room were slow to take off, but gradually patients plucked up the courage to join in, and now it’s a flourishing social group. Lonely patients in the waiting room are encouraged to participate. While members embroidered ‘welcome’ 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 “You haven’t got my language ”.  Offered blue thread, he insisted on red, gold and green, the colours of his birth nation’s flag. He’s now a regular, and for the first time, staff say, he’s smiling.

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 – referral to a range of local, non-clinical services – for social problems. It makes sense.

Hollowed-out social infrastructures have left us all less connected, and the most vulnerable people easily fall through the holes in the net.

In Somerset, Frome was once a busy market town, but over the decades its life-blood drained away. By 2013 the town was flat-lining. The residents were depressed. The GPs and their staff were disheartened and stressed because they couldn’t solve health problems that were essentially social in origin. Again, a GP took the initiative. She worked with the town council and the local Compassionate Communities health group to identify unmet social needs. Now GPs can refer patients to professional ‘health connectors’ who bridge the gap between patients and community resources. As well as practical advice, innovations include ‘talking cafes’, and – so isolated old men can potter in company – ‘men’s sheds’.

Six years on, the people of Frome, their town, the practice – all exude confidence. Patients feel they have choices and are in more control of their lives and health. The attendance figures demonstrate the benefits for the NHS. GP appointments are down 28% and A&E attendances 24%, while in Somerset towns comparable to Frome demands on the NHS continue to rise.  

There’s nothing like a walk, the wilder the better, to blow away brooding thoughts. Studies show that two hours a week in the fresh air is enough for people to feel better, more self-assertive. In the Shetlands, it was the RSPB’s outreach officer who suggested ‘nature prescriptions’.  Now Shetland GPs ‘prescribe’ walks, with tips about what to look out for and do en route. Patients are more active, many lose weight, and their physical and mental health improves. 

Talking groups, walking groups, reading, drawing, sewing groups, gardening, cooking, singing: for almost any activity there will be someone out there who is anxious to share their enthusiasm with other people. Even the housebound can join a world-wide virtual choir. They sing their part and upload it onto the internet where it is combined with everyone else’s contribution. The resulting concert is streamed, along with photos of the participants, so they all share the pleasure of singing together.

You don’t have to be a GP to set the ball rolling. In St Ives, a market town in Cambridgeshire, the vicar, the mayor and a publican joined forces to rebuild their community. Because people were concerned about the suicides of young men they packaged a bundle of outreach activities into, CALM – a  Campaign Against Living Miserably.

Westminster council and many others offer elderly residents a surprising range of activities. Initiatives like these are trying to reinvent communities. Whose responsibility is that?

Governments tend to try to initiate change through stultifying tick-box protocols or by publishing a leaflet – passive dissemination – though the only thing that can be guaranteed to trickle down is rain through a hole in the roof. In its 2019 Long Term Plan, NHS England promises ‘an army’ of 1000 link workers (that’s one for every seven practices) to kick-start social prescribing. But this is a vision not a mechanism.

Social prescribing is a transaction. Some patients will be delighted at the idea, but others, hoping for a miracle pill, may be dubious. Like a medical prescription, a social prescription will only be used if the patient has confidence in the prescriber. So, successful social prescribing still depends on the committment and vision of GPs.

Beveridge’s vision was a welfare state to resolve the backlog of neglected medical problems of the 1940s. The NHS did that job, and health services today are faced with a very different challenge. Social prescribing transforms 21st century lives. And not just for patients. It meets so many modern needs that worn-out GPs can rediscover their zest for their job.

I’ve seen the future of general practice, and it works!

With thanks to Dr Jane Myat of Caversham Group Practice