18 March 2021
International Social Prescribing Day
18 March 2021
Developing parity between social and biomedical prescribing
Johnny Skillicorn-Aston, External Affairs and Pharmaceutical Communications Specialist
Dr Anant Jani, Population Health Specialist, Martin Fellow, University of Oxford
Social prescriptions are a means of linking patients in primary care with sources of support within the community to help improve their health and well-being. There are a large variety of social prescriptions and they can include sports and leisure/art activities as well activities more focused on health, education or skill development.
The context for their application in the UK has largely been as a way to provide under pressure general practitioners with alternative routes to care for their patients.
While effective in load-lifting out people who do not need a specific medical intervention, a wider application could help to deliver value-based primary care1 by improving patient and population-level outcomes while optimising resource utilisation by:
- Reducing reliance on the biomedical model while also giving a route for health and care systems to address social determinants of health
- Working with individuals with long-term physical and mental health conditions so they can build the knowledge, skills and confidence to manage their condition
- Supporting local economies. Because social prescriptions are largely delivered locally, their active use can help to support job creation by funnelling resources to local voluntary, community and social enterprises
- Building stronger communities: The delivery of social prescriptions necessitates that the health and care sector must identify and actively work with and support local community assets, which will in turn help to establish and deepen community connections
The need to act on this greater than ever
84% of general practitioners say they have an unmanageable workload2 and 20% of patients go to their general practitioner for primarily social problems3. 80% of GPs believe social prescriptions should be available through their surgeries4, while 59% acknowledge they could reduce workload.5
Data continues to emerge on the positive impacts on quality of life and wellbeing and the beneficial returns for our health services.6,7
- An average 28% reduction (range: 2–70%) reduction in demand for general practitioner services
- An average 24% reduction (range 8–26.8%) in Accident and Emergency attendances
- An average Social Return on Investment of £2.3 per £1 invested in the first year
Mainstreaming social prescribing should be central in our efforts to manage the rising demand on health services, patient expectations, secure better outcomes and improve patient experience, reduce health inequalities; and all within a national health and care system struggling to sustain performance through the COVID-19 pandemic.
What should we be doing?
While social prescribing addresses non-biomedical needs, there is an example in biomedical prescribing we could assimilate. Formularies, supported with non-randomised control trial mechanisms to capture evidence, could be used to rationalise the use of social prescriptions and ensure they deliver better patient and population outcomes while optimising resource utilisation – a necessary check on making sure that we are not delivering interventions that offer no benefit or, worse, may cause harm.
Formularies collect, filter, fillet and provide prescribers essential information on drugs to ensure safe and effective prescribing.8 In biomedical prescribing, evidence suggests that formulary use at local, regional and national levels increases utilisation rates of formulary drugs and reduces costs, yielding prescribing practices that are appropriate, safe, cost-effective and, ultimately, value based.9-11 This suggests that developing a social prescription formulary could, similarly, standardise this kind of intervention ensure their use is effective, efficient and of high value.
Creating the formulary
There are several steps for creating a formulary including generating evidence, synthesising it and determining pricing of the intervention and how providers are reimbursed. At the moment, it feels a little like the gig economy, no assurances on supply or payment and no formalised commitment.
On the path toward a national social prescription formulary, we have the scope to develop local and regional models that would serve as exemplars and generate evidence to be used in establishing a more robust national model.
Having achieved this goal, a social prescribing formulary can show clear benefits for all healthcare stakeholders –
Patients: Increased choice and information about the risks and benefits of evidence-based social prescriptions;
Prescribers: Decreased risk associated with using social prescriptions because of greater standardisation and evidence base behind social prescriptions;
Payers: Ability to negotiate and bulk purchase standardised social prescriptions and greater transparency on the value of purchases;
Providers of social prescriptions: Standardisation and bulk purchases from payers would allow for more stable and predictable revenue streams (which could also facilitate economies of scale, competition and innovation);
Policy makers: Data on regional and national use of social prescriptions would facilitate more rational resource allocation decisions.
There is hope that successfully built and utilised social prescriptions formularies could lead to the eventual harmonisation of social prescriptions, and an improvement in wellness generally.
Notes
Johnny Skillicorn-Aston is Conclusio lead on external affairs, communications and client and stakeholder relationship management
Dr Anant Jani is Conclusio’s director of clinical insights
Conclusio will be hosting a webinar: Social Prescribing: Building a framework for wellness on 29 April 2021, which Dr Anant Jani will chair. Register here https://us02web.zoom.us/webinar/register/WN_-BuwM3pSTmyS6SOpaYsIRw
Acknowledgement
This blog has been informed by a series of articles published in
Journal of the Royal Society of Medicine; 2019, Vol. 112(11) 459–461
DOI: 10.1177/0141076819848304 and Vol. 112(12) 498–502
DOI: 10.1177/0141076819877555
References
- Watson J, Salisbury C, Jani A, Gray M, McKinstry B and Rosen R. Better value primary care is needed now more than ever. BMJ 2017; 359: j4944.
- NHS England. Universal Personalised Care: Implementing the Comprehensive Model. See https://www.england.nhs.uk/wp-content/uploads/2019/01/universal-personalisedcare. Pdf.
- Westminster Research. A Review of the Evidence Assessing Impact of Social Prescribing on Healthcare Demand and Cost Implications. See https://westminsterresearch.westminster.ac.uk/download/e18716e6c96cc93153baa8e757f8feb602fe99539fa281433535f89af85fb550/297582/review-of-evidence-assessing-impact-ofsocial-prescribing.pdf.
- The Work Foundation. Social Prescribing: A Pathway to Work? See http://www.theworkfoundation.com/wp-content/uploads/2017/02/412_Social_prescribing.pdf.
- Royal College of General Practitioners. Spotlight on the 10 High Impact Actions. See https://www.rcgp.org.uk/-/media/Files/Primary-Care-Development/RCGP-spotlight-on-the-10-high-impact-actions-may-2018.ashx?la=en
- NHS England. Universal Personalised Care: Implementing the Comprehensive Model. See https://www.england.nhs. uk/wp-content/uploads/2019/01/universal-personalisedcare.pdf
- Westminster Research. A Review of the Evidence Assessing Impact of Social Prescribing on Healthcare Demand and Cost Implications. See https://westminsterresearch.westminster.ac.uk/download/e18716e6c96cc93153baa8e757f8feb602fe99539fa281433535f89af85fb550/297582/review-of-evidence-assessing-impact-ofsocial-prescribing.pdf.
- Kendall M and Enright D. Provision of medicines information: the example of the British National Formulary. Br J Clin Pharmacol 2012; 73: 934–938.
- Yeung K, Basu A, Hansen RN, Watkins JB and Sullivan SD. Impact of a value-based formulary on medication utilization, health services utilization, and expenditures. Med Care 2017; 55: 191–198.
- Beardon PH, Brown SV, Mowat DA, Grant JA and McDevitt DG. Introducing a drug formulary to general practice – effects on practice prescribing costs. J R Coll Gen Pract 1987; 37: 305–307.
- Hill-Smith I. Sharing resources to create a district drug formulary: a countywide controlled trial. Br J Gen Pract 1996; 46: 271–275.