Often, our expectations of healthcare are of interventions, medicine and trials to improve our health or conditions we may be suffering with. For a long time, the NHS and private sector have neglected the non-clinical aspects of health which often paradoxically have a larger impact on a patient’s quality of life, wellbeing and productivity. Social prescribing exists as a method to allow GP’s, pharmacists and other healthcare providers to refer patients to a non-clinical service in the community for amelioration or treatment of their condition or confounding co-morbidities.
This type of referral is something seen more in European countries such as France, where schemes exist to integrate individuals into the community to engage in a range of activities and sessions which may contribute to their overall health. This aspect of social prescribing aims to assimilate the group effects of economic and environmental factors by giving patients the tools to complete tasks and engage in activities which may indirectly improve their health. These ideas perhaps are more often seen in nursing home scenarios with arts, crafts and dance employed which dramatically enhances the quality of life, happiness and vigour of the patients.
Social prescribing is often executed well in conjunction with volunteers, charities and other governing bodies which are concerned with the delivery of well-planned interventions and activities. These activities may include arts, mentoring workshops, sports clubs, healthy eating services, gardening, music and drama activities and hobby workshops. Many of these schemes in London have been incredibly successful in promoting health and wellbeing in patients of varying conditions, and works synergistically with NHS and private healthcare guidelines in promoting wellbeing beyond consultations and doctors offices.
Why does it work?
In many cases, the act of beginning a new activity can be daunting to patients, particularly if they are lacking motivation and self esteem due to an illness or social issue. However, many of these schemes utilise group interaction which can serve to boost uptake with social facilitation, ensuring skills are learnt quicker and isolation is diminished in activities where group activity is required. Furthermore, individuals who successfully complete sports, crafts or other hobbies often report a sense of satisfaction and this is related to their self-efficacy, or perceived capacity to complete tasks to a required level. Thus, hobbies may indirectly provide the tools to improve self-efficacy in other areas of their life such as abstaining from drug use, tapering medications and improve mental health conditions such as anxiety and depression.
Schemes in Bristol and Rotherham (Kings Fund, 2018) which used follow-up appointments determined that patients who up took activities due to introduction from social prescribing often had a better outlook, reduced their interaction with A&E services and significantly improved their mental health, which can confound issues with physical illness. Concerns around the cost of this program may also be alleviated by the reduction in use of general NHS and hospital services, with the Rotherham and Bristol schemes achieving a break-even cost in just 18 months post roll-out.
As always, these schemes provide bright short term efficacy, but are yet to be proven in the literature and will potentially be more documented in the next decade to come. Little is known about the long term adherence of individuals to their assigned or discovered activities, as relapse into inactivity is inevitable, and greater still, has implications for reuptake of use of NHS services. However – social prescribing certainly exists as a novel, exciting page in the book that is the complex nature of healthcare in the United Kingdom.