Social prescribing of non-clinical services within Australian primary care: is it more than just a good idea?
The concept of social prescribing has been gaining some traction in Australia recently. The King’s Fund defines social prescribing as a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services [1]. This is a broad definition which implies that social prescribing might refer to a General Practitioner (GP) actively encouraging a patient to participate in Parkrun to help them lose weight and meet new people, through to a chronic disease nurse linking a patient experiencing homelessness to a local housing service.
Social prescribing of non-clinical services has been deemed particularly relevant when a patient is experiencing a range of complex and interdependent conditions such as chronic disease, mental illness, isolation and other social issues, as well as high use of health care. In some cases it might also be very relevant for otherwise highly functional patients such as a lonely new mum at risk of post-natal depression, or someone experiencing acute grief.
Social prescribing has a lot of appeal, particularly when considering the intersection between chronic disease and mental health. For example, as many as 50 per cent of people with diabetes will suffer from a mental health condition like depression or anxiety, which may in turn limit their ability to manage their diabetes well. Social isolation and loneliness have also been linked to increased mortality. [2]
There is also a reasonable, and appealing, argument to suggest that social prescribing might support system efficiency – by connecting more complex and resource intensive patients with relatively low-cost non-clinical services which may reduce their access to high-cost clinical care.
Is this really a new thing?
Many private practice GPs already undertake social prescribing-like activities, but this might be somewhat ad hoc, and they may feel varying levels of confidence and comfort doing so.
Some patients also have access to holistic planning and referrals through the ‘non-health’ sectors such as aged care and NDIS.
In Australia there are many existing models in place to support complex and vulnerable patients in the primary care setting (e.g. care coordinators), or to co-locate and integrate GPs with allied health, social and community services (e.g. Aboriginal Community Controlled Health Organisations, and Victorian Community Health Services).
Can it be scaled and systemised?
With opportunities to better respond to the needs of complex and vulnerable patients, and to realise efficiencies, social prescribing makes a lot of sense; but there are some real and important barriers to increasing social prescribing which need be considered.
Knowing what services, groups or activities are available locally, safe, appropriate, and accessible for their patients will be important for GPs wanting to engage in more social prescribing.
Trialling the inclusion of social and community supports in Primary Health Network HealthPathways might be one way to tackle that. There may also be a role for system navigators to help identify, connect and educate across the health and social sectors.
Being confident that the ‘referral’ is likely to result in a positive outcome, and will not harm, isolate or introduce added complexity to a patient’s circumstance is also very important. Furthermore, for many socially isolated patients, simply suggesting that they engage with a new group or activity might not be realistic if they experience genuine barriers to social interaction, such as lack of transport, anxiety or financial constraints.
Ongoing work is needed to translate existing evidence so that it can be used by GPs and other primary care providers to inform their decision making, and to further build the evidence base about what actually works, for whom, and under what circumstances.
What next?
If social prescribing is to become a significant part of the approach to managing chronic conditions and complex patients, we’ll need a sustained focus on solution-oriented implementation and meaningful evaluation which creates accessible understanding and insight.
****************************
About the author:
Naomi Bromley is an Associate Director in KPMG’s Health, Ageing and Human Services team. Naomi’s areas of interest include primary and community health, Indigenous health and health program evaluation. Naomi is contactable at nbromley1@kpmg.com.au
****************************
References:
[1] The King’s Fund https://www.kingsfund.org.uk/publications/social-prescribing
[2] Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T., Stephenson, D.: Loneliness and social isolation as risk factors for mortality. Perspect. Psychol. Sci. 10, 227–237 (2015)