Leading questions: Charlotte Osborn-Forde

Charlotte Osborn-Forde, CEO of the National Academy for Social Prescribing, describes the evidence and benefits of social prescribing link workers in an interview with Pulse PCN editor Victoria Vaughan

What advice do you have for clinical directors (CDs) for getting the most from their social prescribing link worker?

The first thing is to read the guidance and see what’s possible with a link worker and make sure you understand what the role is.

It’s a band 5 role. It is not about simple signposting. It’s about enabling your practice to offer personalised care, and to have a part of your team that is able to unpick non-medical issues that are affecting patients’ health.

It works really effectively where you have generic link workers and also specialisms. For example, a PCN could recruit a link worker with a background working with children and young people with mental health conditions.

We are now seeing PCNs think about the biggest issues affecting their network, such as very long waiting lists for neurodevelopmental services and young adult mental health services. PCNs can work creatively with local partners and link workers to identify how to support people on those waiting lists through social prescribing.

We’ve seen PCNs recruiting quite diverse teams with specialists that are very targeted to their particular needs. For example, in Kent, patients with neurodevelopmental issues can be referred by GPs but link workers are also looking at GP coding for families that are on the waiting list. They proactively telephone them to ask, ‘How is everything? Do you have any concerns? What more can be done?’

That came from a CD who said they’d made referrals into services that weren’t being progressed because the information wasn’t right on the referral form. They’d needed other bits of data and evidence, so a link worker was taking ownership of that process and also reducing demand on GPs.

Is there any evidence that social prescribing works?  

Social prescribing only became mainstream in 2019 with the additional roles reimbursement scheme (ARRS). And since then, we’ve had a pandemic. Before that there wasn’t even an agreed definition for social prescribing. This meant there was no shared approach. So what would go into an evidence review?

Now, we’ve got the definition of social prescribing, and we start to invest in it and have it delivered in a standard way. Now we’re starting to see evidence as a result of that. The National Academy for Social Prescribing (NASP) collates that evidence and publishes it. That includes looking at the positive impact social prescribing can have on a wide range of outcomes for patients, as well as economic value and reductions in GP appointments and acute secondary appointments.

We’re  now building up a robust picture of evidence and we can provide it for any part of the system.

Previously I was the CEO of Involve Kent, a charity providing social prescribing. We worked with 21 PCNs to provide social prescribing link workers. We were constantly evaluating the impact of that.

One study looked at around 1,000 patients who had accessed a social prescribing link worker, referred by their GP in a PCN. Then we were able to track their A&E usage and unplanned admissions. Depending on the demographic we saw up to 20% reduction in A&E admissions and an 8% reduction in unplanned admissions.

We did that by working with the integrated care board (ICB), pseudonymising their NHS numbers and running that data. That showed us those patients weren’t frequent fliers at A&E, and they weren’t necessarily patients with really complex health needs. They were just people that the GPs felt could benefit from social prescribing.

At  the NASP our academic partners have looked at other examples and compiled evidence reviews that show how social prescribing can reduce pressure on primary care – including reducing GP appointments and A&E visits and saving costs. It can have a significant social return on investment as well.

What could help support social prescribing in primary care? 

We probably need support from NHS England and the Royal College of General Practitioners and others to spread the message of how valuable social prescribing can be to GPs and PCNs, to help them develop their strategies and meet their requirements.

As I’ve said, there is flexibility in the guidance and in how the investment can be used. For example, we’re publishing a guide to supporting children and young people’s health priorities through social prescribing in PCNs, which looks at what they can do and what’s available. But I think there should be more strategic development to help CDs understand the potential and possibilities.

Do you think PCNs realise the potential of social prescribing? 

There is a huge range of understanding. Some really get it and some don’t. Some of that is related to things outside PCNs’ control. What we typically see is in very deprived areas, there’s already a lot of demand on GP practices, and there isn’t always headspace to look at something holistic. Often where we see it move forward, it’s because the CD has always valued a biopsychosocial model. I would encourage PCNs to link up with the local voluntary sector, who can guide them on connecting with local services. For example, all ICBs now have an alliance of key voluntary sector providers in health and wellbeing. They know what might be available, and that expertise and support is valued.

Are PCNs crucial to the use of social prescribing?

I don’t have strong views on the structure of GP practices and how they work together. But it is important that social prescribing teams are able to work across a number of practices.