Guest Post by Richard Luff, member of the CAG network.
The Building a Healthy Sustainable Society event on 19 October, which was supported by NHS England and Public Health England, provided a fascinating outsiders view of how the NHS is facing and planning to deal with massive challenges. This event focused both on the internal, organisational, NHS aspects, as well as the external public facing aspect, though I will just focus here on the later point. Clearly there is a recognition that health is more holistic than the part of the system many of us experience as members of the public, and this is reflected in the thinking/evidence described in the wider social determinants of health . There was a wide acknowledgement of the crisis the NHS is facing and a genuine desire to try to do things differently. As one presenter said, “never let a crisis pass by without using it”.
After the overview presentations, a series of workshops were conducted in the morning and afternoon; Ebbsfleet Healthy new town, Well-being Exeter, Designing healthy communities around green spaces and 7 others. The use of green spaces and social prescribing featured strongly in the programme and I attended both a morning and afternoon session on social prescribing. (Social prescribing enables GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services .) It should be explained here that social prescription needs to be provided on the basis of a patients needs and can range from advice on housing and debts issues, dance classes etc and not just on nature based activities such as working on city farms and conservation activities (though these are shown to be particularly effective).
Though social prescription is only quite small scale (I heard one figure of 5% of the population benefits from this) it has the potential to be transformational with figures quoted of 28% less GP consultation and 25% less people going to A and E where it is used. Its cost is very low, around £1/patient, which could usefully be compared against a background of a doubling of prescriptions for anti-depressants over the period 2005-2015 . Around half the Clinical Commissioning Groups (CCGs) in England are now using social prescription, with South Yorkshire CCG being at the forefront, along with GP surgeries leading the way in some parts of the country.
In the morning Dr Michael Dixon, National Clinical Champion for Social Prescribing, NHS England and Chair, College of Medicine described social prescription as a trojan horse for all the raft of social engagement, patient empowerment and shouldering responsibility that will move the NHS away from a bio medical dominant agenda to a more holistic social and public health system. Dr Simon Opher MBE, GP Gloucester, led a wonderfully engaging workshop session on Social prescribing and how we can deliver it. In the afternoon Sir Sam Everington, Chair of NHS Tower Hamlets CCG explained how the Bromley by Bow practice has led the way for many years, not being satisfied with social prescription in the community but by making the whole GP practice the heart of a huge social prescription project, as part of what he called the need to break the “GP addition culture”.
In order to make social prescription provided through GP practices work well it is important not to make the service over complicated or have it bolted on as an afterthought, it must be considered a genuine option that offers great potential value to the patients. A Community connector service or link is really important for social prescription to work well. This person is someone within, or available to, the GP practice who can both signpost and hold the hand of the member of the public to get them to the activity that works for them. This approach is bearing fruit as it takes a load off the GP, is a one stop shop, brings in community expertise, and provides the all critical stability of social prescription service availability to make this successful.
Some practical advice was provided around how to make social prescription real in any area, including the importance of influence through a champion in the CCG, getting this on the agenda of patient support groups to drive GP practice in this direction and inclusion of social prescription within the NHS Sustainability and Transformation Plans (STPs). NESTA found that 80% of GPs wanted social prescription to be made available in their surgeries , so there appears to be great demand from GPs themselves.
Towards the close of the afternoon David Pencheon, National Director, Sustainable Development Unit shared with us an acronym from a colleague of his; CLANGERS. The NEF identified the 5 ways of well-being  that help make us healthy; Connect, Learn, be Active, take Notice, Give and add to these Eat, Rest and Sleep and you have a formulae for improved well-being.
Perhaps we need a campaign for social prescription in Oxfordshire? At the same time we would need communal food growing groups to prepare for the future demand that this might generate.
If you’d like to find out more about the various food growing projects across the CAG network, why not come along to our Collaborate meetup for such groups. Our next meeting is 7pm on 9 November. Get in touch with Alice for more information: firstname.lastname@example.org
References: http://jech.bmj.com/content/64/4/284  https://www.kingsfund.org.uk/publications/social-prescribing  https://www.theguardian.com/society/2016/jul/05/antidepressant-prescriptions-in-england-double-in-a-decade  https://www.nesta.org.uk/news/social-prescriptions-should-be-available-gp-surgeries-say-four-five-gps  http://neweconomics.org/2008/10/five-ways-to-wellbeing-the-evidence/