Non-pharmacological approaches to treatment and care have become a common topic of discussion, and social prescribing has been referred to in recent years as ‘new’, ‘innovative’ and ‘novel’. Although it is not new by any means, it has not yet gained the traction it needs to in order to truly make the difference it could for people living with long-term conditions.
As was pointed out by Cowan (2020), Sir Roger Bannister wrote a letter to the Lancet back in 1973 suggesting that, rather than prescribing drugs to reduce lipid levels, ‘we should help to swing our patients over to a more positive view of health so that they change their lifestyle to include sufficient exercise’ (Bannister, 1973).
The peculiar, and perhaps ironic, thing about social prescribing is that it takes a medical approach, giving ‘doctor's orders’, to behaviours that used to form an organic part of our daily leisure. We now need prescriptions to tell us to spend time with people that make us happy, to exercise, to eat nourishing foods, slow down, put our phones away and actively engage in activities that make us feel good. The latter may prove the most difficult and may require us to ask ourselves what those activities are in the first place, as many of us will have simply forgotten or even changed since we last checked.
Perhaps a silver lining to the restrictions of the national lockdowns is that restrictions on movement and socialising have led to many people exploring new hobbies that they would not previously have given time to. From a physical and mental health perspective, the ways that people have found to get moving and care for their bodies in this time-taking up home workouts, solo walks or even meditating-could be enormously beneficial in the long term. For many, this has weakened the time, financial and cultural barriers that often discourage people from engaging in a form of exercise that they enjoy.
The King's Fund (2020) referred to social prescribing, having also been known as ‘community referral’, as a means to enable health professionals to be able to refer people to a range of local, non-clinical services. The key is in recognising that people's health and wellbeing are often determined by a range of social, economic and environmental factors, and social prescribing seeks to address this more holistic combination of factors (King's Fund, 2020). It also promotes patient independence and empowerment.
The King's Fund (2020) described schemes delivering social prescribing involving a range of activities typically provided by voluntary and community sector organisations, such as volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports.
This holistic way to address health is designed to support people with a wide range of social, emotional or practical needs, with many schemes being focused on improving mental health and physical wellbeing. The King's Fund (2020) mentioned that those who could benefit from this type of scheme could include people with mild or long-term mental health problems, people with complex needs, those who are socially isolated and those with multiple long-term conditions who frequently attend either primary or secondary healthcare. Therefore, community nurses will become highly familiar with this term, if they are not already.
Rather than directly funding the groups that deliver social interventions, the NHS Long Term Plan (NHS England, 2019) committed funding to the link workers who connect people to a range of support and engagement opportunities mostly led by charity and voluntary organisations in the patient's local area. The NJS Long Term Plan (NHS England, 2019) set a target that, by 2023/24, every GP practice in England will have access to a social prescribing link worker, and 900 000 people will be referred by then. Therefore, community nurses will be directly affected by this and will also be involved in working with link workers. In 2019, the Department of Health and Social Care (DHSC) made £5 million available to establish a National Academy of Social Prescribing, which was formed officially as an independent charity in 2020, with support from a number of partner organisations (King's Fund, 2020), primarily to raise the profile of social prescribing, build the evidence base and share best practice.
The Royal College of Nursing (RCN) also published the beginnings of some promising findings and guidance for nurses who are becoming involved with social prescribing. Pickering and Smyth (2020) commented that it has been estimated that around 20% of patients consult their GP for what is primarily a social problem, with loneliness being a key factor. They looked at feedback from a nurse-led survey on social prescribing. The project objectives were to raise awareness of social prescribing, highlight the role of the nurse in social prescribing, use the available evidence of a nurseled social prescribing project, provide a range of resources to support the successful introduction of social prescribing in a variety of settings and embed social prescribing into the RCN's clinical resources (Pickering and Smyth, 2020).
The survey looked at various social prescribing initiatives, such as walking, football, gardening schemes, ballet for all ages, singing for health and lunch clubs. Demographics across England vary considerably, which has caused the evolution and adaptation of various models of social prescribing, including nurse-led social prescribing, community-led models and voluntary sector models. The patient feedback from nurse-led models showed the advantages of social prescribing included a reduction in isolation and improved social networks, physical health and quality of life and emotional wellbeing.
With the NHS Long Term Plan (NHS England, 2019) estimating that at least 900 000 people will be referred to social prescribing by 2023/24, nurses in the community will, without a doubt, notice their increasing involvement in this practice.