The Asset-Based Health Inquiry launches this week, investigating how best to develop social prescribing. You may have read previous blogs here on how best to collaborate with communities – ‘Them and Us” about the power of citizen leadership; ‘Primary Care and Scale – who should we be collaborating with?’ setting out the need to build out from communities not artificially mandate a scale for working with populations that doesn’t recognise existing community identities.
The report intends to shed light on the amazing work that is already happening. Perhaps the best advice we can give is this:
- Don’t add Social Prescribing on as another project. There are real people making real connections in the community, and health teams already partnering with communities – start there. Learn from them, grow and spread their approach. We met example after example of great work happening. It might not be in primary care, so lift your eyes and seek out people taking an asset-based approach in local government, mental health as well.
- Get out of the way. An asset-based approach generates masses of gifted time, energy, care and compassion. It’s not a service. It’s a way of being part of a community and health professionals can take part but they can’t dictate; they can create the opportunities but then as Alison Cameron says – they need to ‘get out of the way’
- When it works its not a service add-on; it’s a whole way of relating – redefining roles in the practice and re-shaping the way professional relate too and with people in communities. Where it worked people lived and breathed non-judgmental, purposeful, positive belief in and experience of working with all manner of people trusting their potential. Where it stalled it was a service provided by professionals to local people.
- Count friendships. You pay attention to what you count – so what you want more of. We suggest metrics along these lines that get to the heart of the intent of a primary care model of social prescribing:
- Increase in numbers of friends
- Proliferation of citizen-led not sector-led lifestyle support.
- Primary care ‘coverage’ to touch the whole population in a way that is more fairly and equally distributed.
- Reduced demand on general practice, meeting people’s needs and better overall health
You can read the report here. The report has four inspiring case studies – The Alvanley Way (Alvanley Family Practice) The Frome Connections (Frome Medical Centre and Health Connections Mendip) Grenfell: After the Fire (you may have seen the fantastic Fatima Elguenuni at NHS TEDx) Wakefield: Dancing Down the Corridors (Creative Minds, West Yorkshire Partnerships Trust).
We go through a number of dilemmas and myths on purpose, scale, money, metrics, method and language; and the key to developing a sustainable model. For those of you interested in the evidence there is a full literature report too in Section 2.
Here are three things you need to know from the report
1. Start with Need not Demand
You can find more about this here
2. Who Does What – the mix of roles needed
At the heart of supporting people to live good and healthy lives are the need for friends and family, creativity, learning, meaningful activity (hobbies, volunteering), getting out of poverty, navigating the system to get access to services (finances, care, education, health), eating well and being physically and mentally active. No GP appointment can meet this need.
Whilst there is a place for professionals where people need help coping and navigating, the biggest impact comes from people helping each other. The ambition for social prescribing relies on a multitude of volunteers, coordinated by a few volunteer health champions, in turn supported by employed people who nurture, facilitate, develop, ensure probity and governance, and broker funding. Where the ambition of ‘social prescribing’ works well at scale it had this mixture of roles.
3. What is is and What it isn’t
Employing a link worker in itself does not constitute social prescribing.
Where ‘social prescribing’ – taking an asset-based approach works it changes not just the relationship with local people, but how the NHS / Primary Care goes about its work. It catalyses or is part of a new model of care. That means it will evolve, and as it does so no doubt the language will change too.
The energy, exuberance, and happiness we found on our visits was hard to describe but those we met were definitely living a better life.
Here is a Vlog with all that on it!!