People living in Gloucestershire can now access a wide range of health and wellbeing support via social prescribing, explains Ellen Rule, Director of Transformation and Service Redesign at NHS Gloucestershire Clinical Commissioning Group.

Stress and loneliness are just two of the reasons why one in five GP appointments is about wider social needs rather than medical issues. ‘Social prescribing’ enables general practices to refer suitable people to a link worker who can introduce them to a range of local, non-clinical services to support their health and wellbeing, rather than, or alongside, prescribing medication.

Once referred to a social prescribing link worker, people are given time to focus on what matters to them. From those detailed conversations, the link worker takes a holistic approach to connect individuals to community groups and voluntary sector services for practical and emotional support. This approach is known as the universal model of social prescribing.

Creating social prescribing ‘plus’

In Gloucestershire, as well as social prescribers who are employed by GP practices, we also have our own model of social prescribing known as ‘social prescribing plus’.

Social prescribing plus enables us to work with local community and voluntary organisations to set up support groups such as mixed media arts for people with mental health needs. The range of support offered can include non-medical interventions for medical needs, where advisable. For example, GPs can offer options other than pulmonary rehabilitation or physiotherapy to people living with respiratory issues or chronic pain. For example, they can prescribe singing for adults with respiratory conditions to help with breathing, or mixed media arts for adults with persistent pain.

GPs can also offer non-medical interventions to people waiting for specialist appointments. For example, a patient with mental health issues could benefit from Arts on Prescription while waiting for cognitive behavioural therapy.

Promoting community wellbeing

There are a range of projects and programmes that are available across the two models of social prescribing. The social prescribing link worker (universal) model also includes our countywide Community Wellbeing Service, jointly commissioned with Gloucestershire County Council. Through this service we can support people who need help to access local group-led activities such as walking for health, arts groups for social isolation and luncheon clubs for friendship. In 2020/2021, our Community Wellbeing Service supported around 400 adults and children.

The Community Wellbeing Service makes a real difference to local people, offering bespoke support through challenging times. In Gloucestershire, we have seen a 17% reduction in forecasted attendances at accident and emergency departments as a result of people accessing the service. Recent data captured by the service using the Office for National Statistics wellbeing scales also demonstrates a clear positive impact of the service on people’s life satisfaction, self-worth, happiness and anxiety.

Working closely together

Gloucestershire Hospitals NHS Foundation Trust is another key partner in our social prescribing plus model. We use a co-production approach for all of our social prescribing plus programmes, with patients, community organisations, clinicians and commissioners all coming together. We also work closely with Gloucestershire Health and Care NHS Foundation Trust and with primary care colleagues. GPs actively input ideas and feedback on suggestions we might have. We have regular co-production meetings and these enable us to make continuous improvements. They really are key partners; we couldn’t do any of this without them.

Having clinicians involved as part of our co-production approach also has the added benefit of helping to improve understanding around health conditions for the many voluntary organisations we commission to provide support services.

One of the initiatives we offer to people living with chronic obstructive pulmonary disease (COPD) is a 12-week Breathe In Sing Out programme. It’s delivered by local charity Mindsong and supports participants to progress to a community choir as their breath control and confidence improve. Our regular co-production meetings have led to Mindsong having a really good relationship with the respiratory physiotherapists. Now, if someone turns up for a session and has a type of respiratory condition that the Mindsong team haven’t come across before, they can talk to one of the specialist physiotherapists to increase their understanding.

Providing support in all areas

There are more than 2,000 voluntary and community groups in Gloucestershire and we want to engage with these groups and ensure we have a thriving voluntary, community and social enterprise sector. Through our model, if there is a community or voluntary organisation out there, our social prescribers could potentially refer someone to their services.

In Cheltenham and Tewkesbury we commission Caring for Communities and People to provide a food parcel service with a difference. The Pantry Project provides people with a healthier alternative to the standard food parcel. They can choose from fresh meat, dairy, fruit and vegetables to the value of £20, for just £3.50 per week. It helps to empower people to make healthy eating choices. They also develop relationships with the project’s support workers who can signpost them to other services that provide debt, housing, mental health and family support.

Another project that came from our Community Wellbeing Service is an arts initiative for people living with fibromyalgia in the Cotswolds. Our social prescribing link worker had seen a number of people with fibromyalgia and found they would welcome being part of a peer support group. While they have a shared health condition in common, they wanted to meet others but forget about having fibromyalgia for a while. Working with a local arts organisation, they meet weekly to get creative and have fun together.

We also co-commission Artlift to offer Create Well sessions for people with mental health issues as part of Arts on Prescription. People really benefit from the sessions. Last year, 82% of participants reported a significant improvement in their mental wellbeing and 100% of survey respondents said they would continue practising creatively in order to sustain their enhanced mental wellbeing. Those with physical health conditions and multi-morbidities benefit too.

Looking to the future

Over the next couple of years, our plan is to continue to develop our social prescribing approach, focussing next on the development of a social prescribing framework. We see social prescribing as central to the new way of working in our ICS, and a valuable offer that we want to be available, and ‘known’ throughout our community. We will be working with local people, service users, community and voluntary organisations and local clinicians to co-produce the framework. The aim is for everyone to have an understanding of what social prescribing is, what it can mean for people, and how it can be used wherever someone lives. Ultimately, we want to continue to spread the use of social prescribing in a sustainable way throughout our county so we can support more local people to live healthier, happier lives.